Provider Demographics
NPI:1407143506
Name:BLAND, LESLIE RASMUSSEN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:RASMUSSEN
Last Name:BLAND
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4117 GATEWAY PLACE LN
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-3468
Mailing Address - Country:US
Mailing Address - Phone:336-662-3902
Mailing Address - Fax:
Practice Address - Street 1:4117 GATEWAY PLACE LN
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-3468
Practice Address - Country:US
Practice Address - Phone:336-662-3902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-09
Last Update Date:2011-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8774101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional