Provider Demographics
NPI:1619128501
Name:MILLIGAN, LESLIE (MS, MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:
Last Name:MILLIGAN
Suffix:
Gender:F
Credentials:MS, MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2681 TRAILING IVY WAY
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-7671
Mailing Address - Country:US
Mailing Address - Phone:678-858-2033
Mailing Address - Fax:678-482-6532
Practice Address - Street 1:3455 LAWRENCEVILLE SUWANEE RD STE D
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6425
Practice Address - Country:US
Practice Address - Phone:678-858-2033
Practice Address - Fax:678-482-6532
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-09
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004053101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional