Provider Demographics
NPI:1235498726
Name:LEBLANC, KRISTIN KAY (BCCC, CTC, CFLE)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:KAY
Last Name:LEBLANC
Suffix:
Gender:F
Credentials:BCCC, CTC, CFLE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 PEACHTREE PKWY
Mailing Address - Street 2:SUITE 4245
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-7066
Mailing Address - Country:US
Mailing Address - Phone:404-725-6912
Mailing Address - Fax:678-513-1077
Practice Address - Street 1:410 PEACHTREE PKWY
Practice Address - Street 2:SUITE 4245
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-7066
Practice Address - Country:US
Practice Address - Phone:404-725-6912
Practice Address - Fax:678-513-1077
Is Sole Proprietor?:No
Enumeration Date:2012-05-03
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA07103690101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral