Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 2437 | GA |
N | 103T00000X | Psychologist | 2437 | GA |
Y | 103G00000X | Clinical Psychologist | 2437 | GA |
Y | 103TC0700X | Clinical Psychologist | 2437 | GA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 2437 | GA |
NPI | 1033242573 |
---|---|
Provider Name | Dr. Leslie A. Stuart |
First Address | Atlanta, GA 30342-1709 |
Second Address | Atlanta, GA 30342-1709 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2007 |
Last Update Date | 28/12/2011 |