Individual
MR. LESLIE VAN TOOLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMFT
Contact information
Practice address
321 GREENVILLE ST, SUITE A, LAGRANGE, GA 30241-3231
(706) 884-0987
(706) 884-9696
Mailing address
321 GREENVILLE ST, SUITE A, LAGRANGE, GA 30241-3231
(706) 884-0987
(706) 884-9696
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
000733
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000733
STATE LICENSE NUMBER
GA
Enumeration date
02/19/2007
Last updated
07/08/2007
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