Provider Demographics
NPI:1902505696
Name:LECOUNT, CHRISTINE COLVIN
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:COLVIN
Last Name:LECOUNT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 E NC HIGHWAY 54 STE 320
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-2490
Mailing Address - Country:US
Mailing Address - Phone:919-907-3334
Mailing Address - Fax:
Practice Address - Street 1:620 DR CALVIN JONES HWY
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-3107
Practice Address - Country:US
Practice Address - Phone:919-338-2191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-01
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN224396363L00000X
NC5020157363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner