Provider Demographics
NPI:1023477908
Name:COBB, LESLIE M (EDS, LPC)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:M
Last Name:COBB
Suffix:
Gender:F
Credentials:EDS, LPC
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:MARIE
Other - Last Name:MCCLAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:822 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841-3242
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:822 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29841-3242
Practice Address - Country:US
Practice Address - Phone:864-933-3821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-19
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5727101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health