Provider Demographics
NPI:1518539253
Name:TARTAKOVSKY, LETICIA EMANUELLE (LPC)
Entity Type:Individual
Prefix:
First Name:LETICIA
Middle Name:EMANUELLE
Last Name:TARTAKOVSKY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 KELBROOK LN
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-5370
Mailing Address - Country:US
Mailing Address - Phone:804-501-9492
Mailing Address - Fax:
Practice Address - Street 1:5901 KELBROOK LN
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-5370
Practice Address - Country:US
Practice Address - Phone:804-501-9492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701010543101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional