Provider Demographics
NPI:1619538196
Name:BLANK, KARA LEANNE (MA, LPC, NCC)
Entity Type:Individual
Prefix:MS
First Name:KARA
Middle Name:LEANNE
Last Name:BLANK
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:MS
Other - First Name:KARA
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:709 OLD TROLLEY RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-5203
Mailing Address - Country:US
Mailing Address - Phone:843-900-6767
Mailing Address - Fax:843-285-5916
Practice Address - Street 1:709 OLD TROLLEY RD
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-5203
Practice Address - Country:US
Practice Address - Phone:843-900-6767
Practice Address - Fax:843-285-5916
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-25
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
SC9060101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health