Provider Demographics
NPI:1053547869
Name:MARTIN, LESLIE C (LCSW)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:C
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 BUSINESS PARK DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-6521
Mailing Address - Country:US
Mailing Address - Phone:757-497-3670
Mailing Address - Fax:757-499-1947
Practice Address - Street 1:240 BUSINESS PARK DR
Practice Address - Street 2:SUITE 100
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-6521
Practice Address - Country:US
Practice Address - Phone:757-497-3670
Practice Address - Fax:757-499-1947
Is Sole Proprietor?:No
Enumeration Date:2009-06-08
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904007115104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker