Provider Demographics
NPI:1366123267
Name:LESLIE, JONAH WOODSONG (LCMHCA, MS)
Entity type:Individual
Prefix:
First Name:JONAH
Middle Name:WOODSONG
Last Name:LESLIE
Suffix:
Gender:M
Credentials:LCMHCA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 AUTUMN WOODS DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-9336
Mailing Address - Country:US
Mailing Address - Phone:919-923-6143
Mailing Address - Fax:
Practice Address - Street 1:25 AUTUMN WOODS DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-9336
Practice Address - Country:US
Practice Address - Phone:919-923-6143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA18970101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health