Provider Demographics
NPI:1053606848
Name:BRAXTON, LESLIE CAMILLE (MED, LPC, NCC)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:CAMILLE
Last Name:BRAXTON
Suffix:
Gender:F
Credentials:MED, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9830 PRECIOUS STONE DR
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-4164
Mailing Address - Country:US
Mailing Address - Phone:336-508-7413
Mailing Address - Fax:
Practice Address - Street 1:4922 WINDY HILL DR STE A
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-5196
Practice Address - Country:US
Practice Address - Phone:919-961-0334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2015-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8000101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health