Individual
LESLIE SOUTHALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1310 W MAIN ST STE 100, RUSSELLVILLE, AR 72801-2803
(479) 964-2011
Mailing address
19 BUSINESS PARK DR STE 5, GREENBRIER, AR 72058-9286
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
P2408002
AR
Other
Enumeration date
12/15/2020
Last updated
08/30/2024
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