Provider Demographics
NPI:1568601623
Name:LEDAIN, HENRICK (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:HENRICK
Middle Name:
Last Name:LEDAIN
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 NEW POINTE BLVD STE 130 PMB1080
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-1279
Mailing Address - Country:US
Mailing Address - Phone:347-452-7642
Mailing Address - Fax:
Practice Address - Street 1:1108 NEW POINTE BLVD STE 130 PMB1080
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-1279
Practice Address - Country:US
Practice Address - Phone:347-452-7642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-13
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY287660164W00000X
NC5019872363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No164W00000XNursing Service ProvidersLicensed Practical Nurse