Provider Demographics
NPI:1356052278
Name:SANDERS, LESLIE ELAINE (LABA)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:ELAINE
Last Name:SANDERS
Suffix:
Gender:F
Credentials:LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3679 APPLEGATE RD
Mailing Address - Street 2:
Mailing Address - City:HOPE MILLS
Mailing Address - State:NC
Mailing Address - Zip Code:28348-2022
Mailing Address - Country:US
Mailing Address - Phone:615-995-1805
Mailing Address - Fax:
Practice Address - Street 1:351 WAGONER DR STE 325
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-4674
Practice Address - Country:US
Practice Address - Phone:910-491-0061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-12
Last Update Date:2024-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA1491106E00000X
NCRBT-22-248349251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No251S00000XAgenciesCommunity/Behavioral Health