Healthcare Provider Details

I. General information

NPI: 1124841077
Provider Name (Legal Business Name): IVANA JEANNE LECLERC MS,LPCR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2024
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1064 LASKIN RD STE 14C
VIRGINIA BEACH VA
23451-6337
US

IV. Provider business mailing address

6014 EDGELAKE DR
VIRGINIA BEACH VA
23464-4905
US

V. Phone/Fax

Practice location:
  • Phone: 757-233-1500
  • Fax:
Mailing address:
  • Phone: 570-800-3025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0704017114
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: