| NPI | 1184763955 |
|---|---|
| Former Name | LESLIE MARIE MCCULLOUGH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: KS 10642) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: TX 02227) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2020-03-03 |