Basic Information
| Provider Information | |||||||||
| NPI: | 1659552271 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAROLAN | ||||||||
| FirstName: | LESLIE | ||||||||
| MiddleName: | |||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 705 S MANGUM ST | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277013904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9196831607 | ||||||||
| FaxNumber: | 9196831790 | ||||||||
| Practice Location | |||||||||
| Address1: | 705 S MANGUM ST | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277013904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9196831607 | ||||||||
| FaxNumber: | 9196831790 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/26/2007 | ||||||||
| LastUpdateDate: | 11/26/2007 | ||||||||
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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 | 101YP2500X | 4112 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.