Provider Demographics
NPI:1073284162
Name:ICENHOUR COUNSELING
Entity Type:Organization
Organization Name:ICENHOUR COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LESLEY
Authorized Official - Middle Name:BLAIR
Authorized Official - Last Name:ICENHOUR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LCAS-A
Authorized Official - Phone:828-719-8779
Mailing Address - Street 1:242 NETTLE KNOB RD
Mailing Address - Street 2:
Mailing Address - City:WEST JEFFERSON
Mailing Address - State:NC
Mailing Address - Zip Code:28694-7257
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:184 N WATER ST STE 10
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-3556
Practice Address - Country:US
Practice Address - Phone:828-719-8779
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health