Provider Demographics
NPI:1699394445
Name:LEBLANC, CANDACE DI ANNE (ALC, NCC)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:DI ANNE
Last Name:LEBLANC
Suffix:
Gender:F
Credentials:ALC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 RYAN RD
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35057-2758
Mailing Address - Country:US
Mailing Address - Phone:205-540-0232
Mailing Address - Fax:
Practice Address - Street 1:350 RYAN RD
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35057-2758
Practice Address - Country:US
Practice Address - Phone:205-540-0232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-12
Last Update Date:2020-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3405101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health