Provider Demographics
NPI:1710793443
Name:LETIECQ, DAVID R (LPC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:LETIECQ
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1520 BELLE VIEW BLVD UNIT 5310
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22307-6530
Mailing Address - Country:US
Mailing Address - Phone:401-662-1682
Mailing Address - Fax:
Practice Address - Street 1:VILLA ROMERO
Practice Address - Street 2:CALLE 43 #86A-25, APTO 505
Practice Address - City:MEDELLIN
Practice Address - State:ANTIOQUIA
Practice Address - Zip Code:050032
Practice Address - Country:CO
Practice Address - Phone:401-662-1682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-07
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC1368101YP2500X
VA0701003073101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional