Provider Demographics
NPI:1972056422
Name:LEONARD, KRISTAN MARIE (LCMHC)
Entity type:Individual
Prefix:
First Name:KRISTAN
Middle Name:MARIE
Last Name:LEONARD
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:KRISTAN
Other - Middle Name:MARIE
Other - Last Name:INMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:CMR 489 BOX 1384
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09751-0014
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:289 OLMSTED BLVD STE 1
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8730
Practice Address - Country:US
Practice Address - Phone:910-295-6007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-02
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCRBT-15-03491103K00000X
NC14417101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst