Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | ||
N | 225C00000X | Rehabilitation Counselor |
NPI | 1063188597 |
---|---|
Provider Name | Leslie C Preveaux |
First Address | Sugar Hill, GA 30518-7930 |
Second Address | Sugar Hill, GA 30518-7930 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2021 |
Last Update Date | 06/09/2021 |