Provider Demographics
NPI:1710007323
Name:MCKENNA, LESLIE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:
Last Name:MCKENNA
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 1:254 9TH AVENUE DR NE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-3828
Mailing Address - Country:US
Mailing Address - Phone:828-443-8905
Mailing Address - Fax:888-593-3511
Practice Address - Street 1:254 9TH AVENUE DR NE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-3828
Practice Address - Country:US
Practice Address - Phone:828-443-8905
Practice Address - Fax:888-593-3511
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4778101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC4778OtherNC LPC LICENSE