Provider Demographics
NPI:1053782730
Name:MOORE, LESLIE (LMHC, CAP)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:LMHC, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2180 N PARK AVE
Mailing Address - Street 2:SUITE 328
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-2359
Mailing Address - Country:US
Mailing Address - Phone:407-687-5187
Mailing Address - Fax:
Practice Address - Street 1:2180 N PARK AVE
Practice Address - Street 2:SUITE 328
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-2359
Practice Address - Country:US
Practice Address - Phone:407-687-5187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 9515101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health