Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
Y | 101YP1600X | Pastoral Counselor |
NPI | 1184886673 |
---|---|
Provider Name | Miss Lois Marie Leblanc |
First Address | Los Angeles, CA 90003-3727 |
Second Address | Inglewood, CA 90305-2101 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2008 |
Last Update Date | 10/05/2013 |