| Doctor Name: | CAROL LEATHERMAN BRIAN |
| NPI Number: | 1194090472 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPC |
| License Number: | 1712 |
| Business Practice Address: | 580 Main St Many, LA - 714493005 |
| Business Phone Number: | 3182566242 |
| Business Fax Number: | 3182562064 |
| Mailing Address: | 1219 Bermuda Road, NATCHEZ |
| State: | LA |
| Postal Code: | 71456 |
| Phone Number: | 3187878463 |
| Fax Number: | 3184494749 |
| NPI Enumeration Date: | 03/20/2012 |
| NPI Last Update Date: | 03/20/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 1712 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | LA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |