Provider Demographics
NPI:1629267901
Name:WRIGHT, LESLIE L (LPC, NCC, ADC, ASDCS)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:L
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:LPC, NCC, ADC, ASDCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTREE
Mailing Address - State:SC
Mailing Address - Zip Code:29556-2819
Mailing Address - Country:US
Mailing Address - Phone:843-372-3365
Mailing Address - Fax:
Practice Address - Street 1:204 SHORT ST
Practice Address - Street 2:
Practice Address - City:KINGSTREE
Practice Address - State:SC
Practice Address - Zip Code:29556-3927
Practice Address - Country:US
Practice Address - Phone:843-806-2501
Practice Address - Fax:843-484-3641
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
SC18022210101YA0400X
SC7515101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1629267901Medicaid
SCPC2254Medicaid