Provider Demographics
NPI:1366163339
Name:LESLEY WOTTON
Entity type:Organization
Organization Name:LESLEY WOTTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:LESLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WOTTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-921-1933
Mailing Address - Street 1:100 JEFFERSON RD
Mailing Address - Street 2:
Mailing Address - City:WHITEFIELD
Mailing Address - State:NH
Mailing Address - Zip Code:03598-3122
Mailing Address - Country:US
Mailing Address - Phone:603-921-1933
Mailing Address - Fax:
Practice Address - Street 1:111 SARANAC ST
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:NH
Practice Address - Zip Code:03561-4088
Practice Address - Country:US
Practice Address - Phone:603-921-1933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty