Healthcare Provider Details

I. General information

NPI: 1194742858
Provider Name (Legal Business Name): LEN B LECCI PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 09/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 RACINE DR
WILMINGTON NC
28403-8827
US

IV. Provider business mailing address

219 RACINE DR
WILMINGTON NC
28403-8827
US

V. Phone/Fax

Practice location:
  • Phone: 910-791-6277
  • Fax: 910-791-6226
Mailing address:
  • Phone: 910-791-6277
  • Fax: 910-791-6226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3041
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: