Provider Demographics
NPI:1962831198
Name:ROBERTS, LESLIE COURTNEY (LPC, MED, CSAC)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:COURTNEY
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LPC, MED, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 CAMERON GLEN DR STE 600
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-3343
Mailing Address - Country:US
Mailing Address - Phone:703-481-4174
Mailing Address - Fax:703-435-1961
Practice Address - Street 1:1850 CAMERON GLEN DR STE 600
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3343
Practice Address - Country:US
Practice Address - Phone:703-481-4174
Practice Address - Fax:703-435-1961
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005548101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA120705OtherFX CO EMPLOYEE NUMBER