Provider Demographics
NPI:1902918568
Name:WILCOX-NOLAN, LESLIE L (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:L
Last Name:WILCOX-NOLAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 METAIRIE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70005-4300
Mailing Address - Country:US
Mailing Address - Phone:504-833-2885
Mailing Address - Fax:504-833-2885
Practice Address - Street 1:315 METAIRIE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70005-4300
Practice Address - Country:US
Practice Address - Phone:504-833-2885
Practice Address - Fax:504-833-2885
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA339101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5T327Medicare ID - Type Unspecified