Provider Demographics
NPI:1902084544
Name:LEBLANC, L C (MA CCHP RC)
Entity Type:Individual
Prefix:MR
First Name:L
Middle Name:C
Last Name:LEBLANC
Suffix:
Gender:M
Credentials:MA CCHP RC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 W FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98548
Mailing Address - Country:US
Mailing Address - Phone:360-462-3320
Mailing Address - Fax:360-350-4218
Practice Address - Street 1:627 W FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98548
Practice Address - Country:US
Practice Address - Phone:360-462-3320
Practice Address - Fax:360-350-4218
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00055728101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WARC00055728OtherDEPT OF HEALTH