Provider Demographics
NPI:1912377847
Name:HERRICK, LESLIE (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:
Last Name:HERRICK
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 SETHS WAY
Mailing Address - Street 2:
Mailing Address - City:WEST GARDINER
Mailing Address - State:ME
Mailing Address - Zip Code:04345-3259
Mailing Address - Country:US
Mailing Address - Phone:207-232-0554
Mailing Address - Fax:
Practice Address - Street 1:153 HOSPITAL ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-0700
Practice Address - Country:US
Practice Address - Phone:207-232-0554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-05
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC4920101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional