Healthcare Provider Details

I. General information

NPI: 1073284162
Provider Name (Legal Business Name): ICENHOUR COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2021
Last Update Date: 09/28/2021
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

184 N WATER ST STE 10
BOONE NC
28607-3556
US

IV. Provider business mailing address

242 NETTLE KNOB RD
WEST JEFFERSON NC
28694-7257
US

V. Phone/Fax

Practice location:
  • Phone: 828-719-8779
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LESLEY BLAIR ICENHOUR
Title or Position: OWNER, THERAPIST
Credential: LCSW, LCAS-A
Phone: 828-719-8779