Provider Demographics
NPI:1740480656
Name:BENFORD, LESLIE JANE (LPC)
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:JANE
Last Name:BENFORD
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 1:1203 CHIPPEWA RD
Mailing Address - Street 2:
Mailing Address - City:ROCKWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:15557-7214
Mailing Address - Country:US
Mailing Address - Phone:174-919-3267
Mailing Address - Fax:
Practice Address - Street 1:1203 CHIPPEWA RD
Practice Address - Street 2:
Practice Address - City:ROCKWOOD
Practice Address - State:PA
Practice Address - Zip Code:15557-7214
Practice Address - Country:US
Practice Address - Phone:717-491-9326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC002668101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional