Provider Demographics
NPI:1861789174
Name:PEGRAM, LESLIE RANEY (LPC)
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:RANEY
Last Name:PEGRAM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 E SAGEBRUSH LN
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-9335
Mailing Address - Country:US
Mailing Address - Phone:912-660-1312
Mailing Address - Fax:
Practice Address - Street 1:111 E SAGEBRUSH LN
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-9335
Practice Address - Country:US
Practice Address - Phone:912-660-1312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-07
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005277101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor