Provider Demographics
NPI:1508920968
Name:LE BLANC, SELENA MARGARITA (MFTT)
Entity Type:Individual
Prefix:MS
First Name:SELENA
Middle Name:MARGARITA
Last Name:LE BLANC
Suffix:
Gender:F
Credentials:MFTT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2999 NORTH TEXAS
Mailing Address - Street 2:#21
Mailing Address - City:FAIRFIELD,
Mailing Address - State:CA
Mailing Address - Zip Code:94533
Mailing Address - Country:US
Mailing Address - Phone:707-655-5599
Mailing Address - Fax:
Practice Address - Street 1:1745 ENTERPRISE DR BLDG 2
Practice Address - Street 2:SUITE I-64
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-5801
Practice Address - Country:US
Practice Address - Phone:707-427-6640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health