Provider Demographics
NPI:1932687589
Name:LESLIE T HERHOLD LCSW LLC
Entity Type:Organization
Organization Name:LESLIE T HERHOLD LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:T
Authorized Official - Last Name:HERHOLD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:337-849-4502
Mailing Address - Street 1:370 APOLLO AVE
Mailing Address - Street 2:
Mailing Address - City:GULF SHORES
Mailing Address - State:AL
Mailing Address - Zip Code:36542-2899
Mailing Address - Country:US
Mailing Address - Phone:337-849-4502
Mailing Address - Fax:
Practice Address - Street 1:232 PROFESSIONAL CT STE A
Practice Address - Street 2:
Practice Address - City:GULF SHORES
Practice Address - State:AL
Practice Address - Zip Code:36542-3523
Practice Address - Country:US
Practice Address - Phone:251-202-9003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-04
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty