Provider Demographics
NPI:1952466658
Name:LEROY, GEORGE ROGER (LCAS, LPC)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:ROGER
Last Name:LEROY
Suffix:
Gender:M
Credentials:LCAS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1544
Mailing Address - Street 2:
Mailing Address - City:BLACK MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28711-1544
Mailing Address - Country:US
Mailing Address - Phone:828-713-2163
Mailing Address - Fax:
Practice Address - Street 1:130 CENTER AVE
Practice Address - Street 2:
Practice Address - City:BLACK MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28711-3509
Practice Address - Country:US
Practice Address - Phone:828-620-0786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-25
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC846101YA0400X
NC4198101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)