Provider Demographics
NPI:1720434954
Name:DEMARCO, LESLIE (LMHC)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:DEMARCO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 EASTSIDE ST SE
Mailing Address - Street 2:STE H
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-2440
Mailing Address - Country:US
Mailing Address - Phone:360-349-6446
Mailing Address - Fax:844-831-8511
Practice Address - Street 1:1101 EASTSIDE ST SE
Practice Address - Street 2:STE H
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-2440
Practice Address - Country:US
Practice Address - Phone:360-349-6446
Practice Address - Fax:844-831-8511
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-06
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH 60604130101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2058854Medicaid