Provider Demographics
NPI:1043993082
Name:LEOPARD, NOELLE CLAIRESSE
Entity Type:Individual
Prefix:
First Name:NOELLE
Middle Name:CLAIRESSE
Last Name:LEOPARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 WOODS LAKE RD STE 712
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-2765
Mailing Address - Country:US
Mailing Address - Phone:864-242-0005
Mailing Address - Fax:
Practice Address - Street 1:25 WOODS LAKE RD STE 712
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-2765
Practice Address - Country:US
Practice Address - Phone:864-242-0005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8606101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health