Provider Demographics
NPI:1598462772
Name:HAUGE, LESLIE M (LPC)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:M
Last Name:HAUGE
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 1:161 ALDBOURNE DR
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-2305
Mailing Address - Country:US
Mailing Address - Phone:860-989-9523
Mailing Address - Fax:
Practice Address - Street 1:161 ALDBOURNE DR
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-2305
Practice Address - Country:US
Practice Address - Phone:860-989-9523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-08
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT46.006087101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional