Provider Demographics
NPI:1801675863
Name:LEBLANC, SAGE (APCC)
Entity type:Individual
Prefix:
First Name:SAGE
Middle Name:
Last Name:LEBLANC
Suffix:
Gender:F
Credentials:APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 SAPPHIRE ST APT 7
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-1031
Mailing Address - Country:US
Mailing Address - Phone:801-834-5059
Mailing Address - Fax:
Practice Address - Street 1:1202 KETTNER BLVD # B
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-3338
Practice Address - Country:US
Practice Address - Phone:619-365-9958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13857101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional