Provider Demographics
NPI:1730425687
Name:HERHOLD, LESLIE THERIOT (LCSW)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:THERIOT
Last Name:HERHOLD
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 1:370 APOLLO AVE
Mailing Address - Street 2:
Mailing Address - City:GULF SHORES
Mailing Address - State:AL
Mailing Address - Zip Code:36542-2899
Mailing Address - Country:US
Mailing Address - Phone:337-849-4502
Mailing Address - Fax:
Practice Address - Street 1:232 PROFESSIONAL CT STE A
Practice Address - Street 2:
Practice Address - City:GULF SHORES
Practice Address - State:AL
Practice Address - Zip Code:36542-3523
Practice Address - Country:US
Practice Address - Phone:251-202-9003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-21
Last Update Date:2023-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA93491041C0700X
AL4348C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical