Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | 07103690 | GA |
NPI | 1235498726 |
---|---|
Provider Name | Kristin Kay Leblanc |
First Address | Cumming, GA 30041-7066 |
Second Address | Cumming, GA 30041-7066 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2012 |
Last Update Date | 05/09/2014 |