Provider Demographics
NPI:1417182940
Name:LEATHERS, KRISTIN DIANE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:DIANE
Last Name:LEATHERS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:131 W LEBANON ST
Mailing Address - Street 2:SUITE C&E
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-2935
Mailing Address - Country:US
Mailing Address - Phone:336-786-1922
Mailing Address - Fax:336-786-1923
Practice Address - Street 1:131 W LEBANON ST
Practice Address - Street 2:SUITE C&E
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-2935
Practice Address - Country:US
Practice Address - Phone:336-716-0800
Practice Address - Fax:336-716-0822
Is Sole Proprietor?:No
Enumeration Date:2009-05-28
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7379101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional