Provider Demographics
NPI:1891564886
Name:LESLIE, EVERITTE III
Entity Type:Individual
Prefix:MR
First Name:EVERITTE
Middle Name:
Last Name:LESLIE
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 141
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:NC
Mailing Address - Zip Code:27342-0141
Mailing Address - Country:US
Mailing Address - Phone:609-816-4459
Mailing Address - Fax:
Practice Address - Street 1:6903 KEENELAND DR
Practice Address - Street 2:
Practice Address - City:WHITSETT
Practice Address - State:NC
Practice Address - Zip Code:27377-9842
Practice Address - Country:US
Practice Address - Phone:609-816-4459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-01
Last Update Date:2024-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)