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General NPI Number Information
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NPI Number | 1710793443
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Entity Type | Individual
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Provider Name | DAVID R LETIECQ LPC
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Gender | Male
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Dates
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Enumeration Date | 12/07/2024
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Last Update Date | 03/06/2026
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Provider Practice Location Address
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Address Line | VILLA ROMERO CALLE 43 #86A-25, APTO 505
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City | MEDELLIN
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State | ANTIOQUIA
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Zip | 050032
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Country | CO
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Telephone | 401-662-1682
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Fax |
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Provider Business Mailing Address
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Address Line | 1520 BELLE VIEW BLVD UNIT 5310
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City | ALEXANDRIA
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State | VA
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Zip | 22307-6530
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Country | US
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Telephone | 401-662-1682
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LC16767
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PRC1368
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License Number State | DC
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701003073
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License Number State | VA
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