Provider Demographics
NPI:1871191262
Name:WEAVER, LESLIE N (LPC-S)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:N
Last Name:WEAVER
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:656 TOWNSEND CIRCLE
Mailing Address - Street 2:CHICKASAW
Mailing Address - City:ALABAMA
Mailing Address - State:AL
Mailing Address - Zip Code:36611
Mailing Address - Country:US
Mailing Address - Phone:251-751-7076
Mailing Address - Fax:
Practice Address - Street 1:656 TOWNSEND CIRCLE
Practice Address - Street 2:CHICKASAW
Practice Address - City:ALABAMA
Practice Address - State:AL
Practice Address - Zip Code:36611
Practice Address - Country:US
Practice Address - Phone:251-751-7076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2991101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional