Provider Demographics
NPI:1962033449
Name:BOWLLAN, LESLIE (MS, LCMHC)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:
Last Name:BOWLLAN
Suffix:
Gender:F
Credentials:MS, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20816 N MAIN ST STE 203
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-8468
Mailing Address - Country:US
Mailing Address - Phone:704-464-2232
Mailing Address - Fax:
Practice Address - Street 1:20816 N MAIN ST STE 203
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-8468
Practice Address - Country:US
Practice Address - Phone:704-464-2232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-03
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12436101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health