Provider Demographics
NPI:1013158963
Name:LAURIEN, LETITIA N (LCSW)
Entity Type:Individual
Prefix:
First Name:LETITIA
Middle Name:N
Last Name:LAURIEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1233 23RD ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23607-4801
Mailing Address - Country:US
Mailing Address - Phone:772-678-1397
Mailing Address - Fax:
Practice Address - Street 1:2204 EXECUTIVE DR
Practice Address - Street 2:SUITE A
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-6602
Practice Address - Country:US
Practice Address - Phone:757-644-3989
Practice Address - Fax:866-813-7798
Is Sole Proprietor?:No
Enumeration Date:2009-03-23
Last Update Date:2023-08-07
Deactivation Date:2023-07-17
Deactivation Code:
Reactivation Date:2023-08-04
Provider Licenses
StateLicense IDTaxonomies
FLSW16560101YM0800X, 104100000X, 1041C0700X
VA09040070771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4945573Medicaid
VAC03714Medicare PIN
VA022475H14Medicare PIN