Provider Demographics
NPI:1134538655
Name:STELLJES NANSON, LESLIE ERIN (PSYD)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:ERIN
Last Name:STELLJES NANSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:
Other - Last Name:STELLJES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11760 SUNRISE VALLEY DR
Mailing Address - Street 2:#814
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-1411
Mailing Address - Country:US
Mailing Address - Phone:703-677-8633
Mailing Address - Fax:
Practice Address - Street 1:1900 CAMPUS COMMONS DR
Practice Address - Street 2:SUITE 100
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-1561
Practice Address - Country:US
Practice Address - Phone:703-677-8633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810005240103TC0700X
DCPSYA00052103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical