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Individual

JASON M. LESLIE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
LICSW, PIP

Contact information

Practice address
3311 BOB WALLACE AVE SW STE 103, HUNTSVILLE, AL 35805-4064
(256) 258-9341
Mailing address
1034 23RD ST S STE 202, BIRMINGHAM, AL 35205-2462
(256) 533-1970
(256) 705-6477

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1658-4698C
AL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
330000014
AL
Enumeration date
09/21/2017
Last updated
03/05/2024
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