Provider Demographics
NPI:1235388497
Name:LEBLANC, COLLEEN M (LMSW, LISAC)
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:M
Last Name:LEBLANC
Suffix:
Gender:F
Credentials:LMSW, LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8727 S PRIEST DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-1915
Mailing Address - Country:US
Mailing Address - Phone:480-227-2706
Mailing Address - Fax:480-831-9274
Practice Address - Street 1:8727 S PRIEST DR
Practice Address - Street 2:SUITE 101
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-1915
Practice Address - Country:US
Practice Address - Phone:480-227-2706
Practice Address - Fax:480-831-9274
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-12
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC10393101YA0400X
AZLMSW12240104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker