Provider Demographics
NPI:1669502605
Name:LEBLANC, LOIS GAIL (LCPC)
Entity type:Individual
Prefix:
First Name:LOIS
Middle Name:GAIL
Last Name:LEBLANC
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 1:800 W LOVELL RD
Mailing Address - Street 2:
Mailing Address - City:LOVELL
Mailing Address - State:ME
Mailing Address - Zip Code:04051-3337
Mailing Address - Country:US
Mailing Address - Phone:207-925-1072
Mailing Address - Fax:
Practice Address - Street 1:639 MAIN ST
Practice Address - Street 2:
Practice Address - City:FRYEBURG
Practice Address - State:ME
Practice Address - Zip Code:04037-1124
Practice Address - Country:US
Practice Address - Phone:207-935-2340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC2070101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor