Provider Demographics
NPI:1184886673
Name:LEBLANC, LOIS MARIE (PHD)
Entity type:Individual
Prefix:MISS
First Name:LOIS
Middle Name:MARIE
Last Name:LEBLANC
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 E 92ND ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90003-3727
Mailing Address - Country:US
Mailing Address - Phone:323-778-7254
Mailing Address - Fax:323-777-1025
Practice Address - Street 1:3425 W MANCHESTER BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90305-2101
Practice Address - Country:US
Practice Address - Phone:323-778-7254
Practice Address - Fax:323-777-1025
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)