Provider Demographics
NPI:1326828872
Name:SAM LEBLANC COUNSELING LLC
Entity Type:Organization
Organization Name:SAM LEBLANC COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEBLANC
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:207-358-9316
Mailing Address - Street 1:615 CONGRESS ST STE 601B
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-5361
Mailing Address - Country:US
Mailing Address - Phone:207-358-9316
Mailing Address - Fax:
Practice Address - Street 1:615 CONGRESS ST STE 601B
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-5361
Practice Address - Country:US
Practice Address - Phone:207-358-9316
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health