Individual
GINA M LESLIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
2901 BERTLAND AVE APT 1237, DURHAM, NC 27705-6825
(573) 397-2846
Mailing address
2901 BERTLAND AVE APT 1237, DURHAM, NC 27705-6825
(573) 397-2846
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
0810008022
VA
103T00000X
Psychologist
38068
TX
103TC0700X
Clinical Psychologist
Primary
2003030084
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
499012607
—
MO
Enumeration date
11/01/2006
Last updated
03/26/2024
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