1841227345 NPI number — LESLIE BORLAND CULBERTSON LCSW CSAC LSATP

Table of content: LESLIE BORLAND CULBERTSON LCSW CSAC LSATP (NPI 1841227345)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841227345 NPI number — LESLIE BORLAND CULBERTSON LCSW CSAC LSATP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CULBERTSON
Provider First Name:
LESLIE
Provider Middle Name:
BORLAND
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW CSAC LSATP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841227345
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2328 BAYVILLE ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VIRGINIA BEACH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23455
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-460-9857
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3755 EAST VIRGINIA BEACH BLVD
Provider Second Line Business Practice Location Address:
NORFOLK COMMUNITY SERVICES BOARD
Provider Business Practice Location Address City Name:
NORFOLK
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23502-3238
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-664-7699
Provider Business Practice Location Address Fax Number:
757-664-7698
Provider Enumeration Date:
06/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  0904003987 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com