Provider Demographics
NPI:1609566215
Name:WEIR, LESLIE ELIZE (LCSW)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:ELIZE
Last Name:WEIR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3615 HADLEY PL
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-8402
Mailing Address - Country:US
Mailing Address - Phone:678-646-8211
Mailing Address - Fax:
Practice Address - Street 1:3615 HADLEY PL
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30039-8402
Practice Address - Country:US
Practice Address - Phone:678-646-8211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0070321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical