Provider Demographics
NPI:1891853784
Name:DURR, LESLIE M (PHD, PMHCNS-BC)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:M
Last Name:DURR
Suffix:
Gender:F
Credentials:PHD, PMHCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3074 DOCTORS XING
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-5733
Mailing Address - Country:US
Mailing Address - Phone:434-973-2062
Mailing Address - Fax:
Practice Address - Street 1:1149 ROSE HILL DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-5161
Practice Address - Country:US
Practice Address - Phone:434-293-2611
Practice Address - Fax:434-296-2928
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0015000153364SP0809X, 364SP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent