Basic Information
| Provider Information | |||||||||
| NPI: | 1962728352 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | LESLIE | ||||||||
| MiddleName: | L. | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW, CCTP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 744786 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303744786 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048342450 | ||||||||
| FaxNumber: | 7046715331 | ||||||||
| Practice Location | |||||||||
| Address1: | 1212 SPRUCE ST STE 315 | ||||||||
| Address2: | |||||||||
| City: | BELMONT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280123386 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048653848 | ||||||||
| FaxNumber: | 7048543086 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2010 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 11/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 0904007269 | VA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | C006756 | NC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 000816420001 | 01 | NC | UHC - OPTUM | OTHER | 6007532 | 05 | NC | MEDICAID | 17431 | 01 | NC | BLUE CROSS BLUE SHIELD OF NORTH CAROLINA | OTHER | 13604553 | 01 | NC | CIGNA | OTHER | 5092840 | 01 | NC | AETNA | OTHER | 928979 | 01 | NC | AVAILITY | OTHER |