Provider Demographics
NPI:1972056422
Name:LEONARD, KRISTAN (RBT)
Entity Type:Individual
Prefix:
First Name:KRISTAN
Middle Name:
Last Name:LEONARD
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:KRISTAN
Other - Middle Name:
Other - Last Name:INMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:84 FAIRWAY LN
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27332-9654
Mailing Address - Country:US
Mailing Address - Phone:772-240-6139
Mailing Address - Fax:
Practice Address - Street 1:5816 CREEDMOOR RD
Practice Address - Street 2:SUITE 104
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-2310
Practice Address - Country:US
Practice Address - Phone:910-879-6102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCRBT-15-03491103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst