Provider Demographics
NPI:1932771888
Name:LETSINGER, LATRICIA CLARK (EXECUTIVE DIRECTOR)
Entity Type:Individual
Prefix:MRS
First Name:LATRICIA
Middle Name:CLARK
Last Name:LETSINGER
Suffix:
Gender:F
Credentials:EXECUTIVE DIRECTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5520 GREENWICH RD STE 204B
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-6541
Mailing Address - Country:US
Mailing Address - Phone:757-598-4787
Mailing Address - Fax:866-835-4610
Practice Address - Street 1:5520 GREENWICH RD STE 204B
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-6541
Practice Address - Country:US
Practice Address - Phone:757-598-4787
Practice Address - Fax:866-835-4610
Is Sole Proprietor?:No
Enumeration Date:2021-07-12
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA3817171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1932771888Medicaid