Basic Information
| Provider Information | |||||||||
| NPI: | 1104253970 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LESLEY | ||||||||
| FirstName: | DIANE | ||||||||
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| Credential: | SCHOOL PSYCHOLOGIST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7003 FIELDHURST CT | ||||||||
| Address2: | |||||||||
| City: | ALEXANDRIA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 223155632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3135300068 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1200 1ST ST NE FL 9 | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200027953 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2024425885 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2013 | ||||||||
| LastUpdateDate: | 10/10/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TS0200X | DC | Y | Behavioral Health & Social Service Providers | Psychologist | School |
No ID Information.