Provider Demographics
NPI:1194090472
Name:BRIAN, CAROL LEATHERMAN (LPC)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:LEATHERMAN
Last Name:BRIAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1219 BERMUDA ROAD
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:LA
Mailing Address - Zip Code:71456
Mailing Address - Country:US
Mailing Address - Phone:318-787-8463
Mailing Address - Fax:318-449-4749
Practice Address - Street 1:580 MAIN ST
Practice Address - Street 2:
Practice Address - City:MANY
Practice Address - State:LA
Practice Address - Zip Code:71449-3005
Practice Address - Country:US
Practice Address - Phone:318-256-6242
Practice Address - Fax:318-256-2064
Is Sole Proprietor?:No
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1712101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional