Individual
LESLIE D. MAVROMATIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
527 MEDICAL PARK DR, BRIDGEPORT, WV 26330-9008
(304) 933-3885
(304) 933-3887
Mailing address
527 MEDICAL PARK DR, BRIDGEPORT, WV 26330-9008
(304) 933-3885
(304) 933-3887
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
DP00944782
WV
Other
Enumeration date
02/08/2017
Last updated
02/08/2017
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