Provider Demographics
NPI:1821267139
Name:LEONARD, CAROL LEE (LCPC)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:LEE
Last Name:LEONARD
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 TANDBERG TRL
Mailing Address - Street 2:SUITE E
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062-5206
Mailing Address - Country:US
Mailing Address - Phone:207-653-4517
Mailing Address - Fax:
Practice Address - Street 1:110 TANDBERG TRL
Practice Address - Street 2:SUITE E
Practice Address - City:WINDHAM
Practice Address - State:ME
Practice Address - Zip Code:04062-5206
Practice Address - Country:US
Practice Address - Phone:207-653-4517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-21
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC1901101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional