Individual
DR. ANDIE MAIKA LESLIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
X
Credential
PH.D.
Contact information
Practice address
516 CYPRESS ST, FORT BRAGG, CA 95437-5410
(707) 961-0308
Mailing address
PO BOX 2077, UKIAH, CA 95482-2077
(707) 467-2010
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSB94027727
CA
Other
Enumeration date
07/10/2017
Last updated
07/16/2024
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