Provider Demographics
NPI:1295992832
Name:MCLAUGHLIN, LESLIE PAULINE (MS)
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:PAULINE
Last Name:MCLAUGHLIN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:PAULINE
Other - Last Name:MCLAUGHLIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCPC
Mailing Address - Street 1:3905 NATIONAL DR STE 160
Mailing Address - Street 2:
Mailing Address - City:BURTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20866-6124
Mailing Address - Country:US
Mailing Address - Phone:410-371-9105
Mailing Address - Fax:
Practice Address - Street 1:3905 NATIONAL DR STE 160
Practice Address - Street 2:
Practice Address - City:BURTONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20866-6124
Practice Address - Country:US
Practice Address - Phone:410-371-9105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD4503101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD055854100Medicaid