Healthcare Provider Details

I. General information

NPI: 1114993649
Provider Name (Legal Business Name): LETITIA RENEE HAWKINS-BEATTY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 06/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5650 HOLLINS RD
ROANOKE VA
24019-5056
US

IV. Provider business mailing address

5650 HOLLINS RD
ROANOKE VA
24019-5056
US

V. Phone/Fax

Practice location:
  • Phone: 540-265-8923
  • Fax: 540-265-7663
Mailing address:
  • Phone: 540-265-8923
  • Fax: 540-265-7663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0701003535
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: