Provider Demographics
NPI:1649673419
Name:LESLIE, CARLA P (LMHC)
Entity type:Individual
Prefix:MS
First Name:CARLA
Middle Name:P
Last Name:LESLIE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:P
Other - Last Name:ROSIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:6360 TECHSTER BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33966
Mailing Address - Country:US
Mailing Address - Phone:239-223-2751
Mailing Address - Fax:239-561-2933
Practice Address - Street 1:228 PLAZA DR
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33936-6054
Practice Address - Country:US
Practice Address - Phone:239-491-8204
Practice Address - Fax:239-491-6217
Is Sole Proprietor?:No
Enumeration Date:2014-10-07
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH15457101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022755800Medicaid