Provider Demographics
NPI:1780734467
Name:HEALTHY BOUNDARIES LLC
Entity type:Organization
Organization Name:HEALTHY BOUNDARIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER-MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:LEBLANC
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LCAS, CCAS
Authorized Official - Phone:910-794-1956
Mailing Address - Street 1:3431 SPARROW HAWK CT
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28409-2538
Mailing Address - Country:US
Mailing Address - Phone:910-794-1956
Mailing Address - Fax:
Practice Address - Street 1:1920 TRADD CT
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-6637
Practice Address - Country:US
Practice Address - Phone:910-343-6890
Practice Address - Fax:910-332-1233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6003758Medicaid
NC1400COtherBLUE CROSS BLUE SHEILD
NC2870872Medicare ID - Type Unspecified