Provider Demographics
NPI:1932827110
Name:MONTGOMERY, LESLIE NOELLE CORRAO
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:NOELLE CORRAO
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3106 EASTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37415-5821
Mailing Address - Country:US
Mailing Address - Phone:770-846-1972
Mailing Address - Fax:
Practice Address - Street 1:6550 OLD DAYTON PIKE
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-2654
Practice Address - Country:US
Practice Address - Phone:423-922-9426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health