Provider Demographics
NPI:1205920576
Name:COX, LESLIE MICHELE (LCSW)
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:MICHELE
Last Name:COX
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:MICHELE
Other - Last Name:ROBISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2522 CHAMBERS RD STE 124
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-6962
Mailing Address - Country:US
Mailing Address - Phone:949-491-1122
Mailing Address - Fax:
Practice Address - Street 1:2522 CHAMBERS RD STE 124
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-6962
Practice Address - Country:US
Practice Address - Phone:949-491-1122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 212221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1205920576OtherIRS