Provider Demographics
NPI:1609022029
Name:LESLIE, JESSICA WILEY (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:WILEY
Last Name:LESLIE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:JESSICA
Other - Middle Name:RENEE
Other - Last Name:WILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:126 DARCY DR
Mailing Address - Street 2:
Mailing Address - City:ARCHER LODGE
Mailing Address - State:NC
Mailing Address - Zip Code:27527-7309
Mailing Address - Country:US
Mailing Address - Phone:337-349-9662
Mailing Address - Fax:
Practice Address - Street 1:625 E KALISTE SALOOM RD STE 400N
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-2540
Practice Address - Country:US
Practice Address - Phone:337-504-3802
Practice Address - Fax:800-398-9547
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-18
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1038931041C0700X
LA85701041C0700X
FLSW156761041C0700X
MELC173541041C0700X
AZ202611041C0700X
NCC0080481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical