Provider Demographics
NPI:1457569832
Name:LOVESTEAD, LESLIE R (MA)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:R
Last Name:LOVESTEAD
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8510 WILD SPRUCE DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22153-1800
Mailing Address - Country:US
Mailing Address - Phone:703-451-0867
Mailing Address - Fax:703-451-0867
Practice Address - Street 1:8510 WILD SPRUCE DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22153-1800
Practice Address - Country:US
Practice Address - Phone:703-451-0867
Practice Address - Fax:703-451-0867
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist