Provider Demographics
NPI:1801022819
Name:HARRISON, LESLIE JENNICE (LMFT)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:JENNICE
Last Name:HARRISON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 ALTAMA CONNECTOR # 279
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31525-1888
Mailing Address - Country:US
Mailing Address - Phone:850-771-8882
Mailing Address - Fax:
Practice Address - Street 1:347 COLLEGE ST APT 5G
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-0404
Practice Address - Country:US
Practice Address - Phone:850-771-8882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-04
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT000969106H00000X
ARM1806011106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist