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Organization
LESLIE AS DOUGLASS LICENSED CLINICAL SOCIAL WORKER LLC
Active
Organization
LESLIE AS DOUGLASS LICENSED CLINICAL SOCIAL WORKER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LESLIE AS DOUGLASS MSW, LCSW (PRESIDENT/OWNER)
(765) 357-8118
Entity
Organization
Contact information
Practice address
55 W. WASHINGTON ST., FRANKFORT, IN 46041-1923
(765) 357-8118
(765) 766-4241
Mailing address
PO BOX 397, FRANKFORT, IN 46041-0397
(765) 357-8118
(765) 766-4241
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
33003543A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200461950
—
IN
Enumeration date
06/03/2006
Last updated
11/19/2011
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