Provider Demographics
NPI:1598413114
Name:MYLES, LESLIE E E (LPC)
Entity Type:Individual
Prefix:MS
First Name:LESLIE E
Middle Name:E
Last Name:MYLES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 HIGHWIND WAY
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-4680
Mailing Address - Country:US
Mailing Address - Phone:140-493-6290
Mailing Address - Fax:
Practice Address - Street 1:225 HIGHWIND WAY
Practice Address - Street 2:
Practice Address - City:FAIRBURN
Practice Address - State:GA
Practice Address - Zip Code:30213-4680
Practice Address - Country:US
Practice Address - Phone:140-493-6290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-13
Last Update Date:2022-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC012576101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty