Provider Demographics
NPI:1831210483
Name:MARTIN, LESLIE MARIE (LCSW, CSAC)
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:MARIE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LCSW, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6805 INNESFREE WAY
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-4414
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:108 ELDEN ST
Practice Address - Street 2:SUITE 15-C
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4828
Practice Address - Country:US
Practice Address - Phone:703-796-6380
Practice Address - Fax:703-796-6381
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904005772101Y00000X
VA0710101842101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)