Provider Demographics
NPI:1013429547
Name:RICHARDSON, LESLIE (LCMHC)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 FREEMAN MILL RD
Mailing Address - Street 2:
Mailing Address - City:HAMLET
Mailing Address - State:NC
Mailing Address - Zip Code:28345-8816
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:115 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HAMLET
Practice Address - State:NC
Practice Address - Zip Code:28345-3215
Practice Address - Country:US
Practice Address - Phone:910-883-0507
Practice Address - Fax:910-557-1929
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-24
Last Update Date:2025-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13480101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCA13480OtherLPC LICENSE
NCA13480Medicaid