Individual provider Active NPI

Letitia N Laurien, LCSW

  • Clinical Social Worker
  • Hampton, VA
National Provider Identifier
1013158963
Registry record updated Aug 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
SW16560 Issued in FL
Practice address
2204 Executive Dr
Suite a
Hampton, VA 23666-6602
Phone
(757) 644-3989
Fax
(866) 813-7798
NPI assigned
Mar 23, 2009
Reactivated
Aug 4, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X SW16560 FL
Social Worker 104100000X SW16560 FL
Clinical Social Worker 1041C0700X 0904007077 VA
Clinical Social Worker 1041C0700X SW16560 FL Primary

Addresses

Primary practice location

2204 Executive Dr
Suite a
Hampton, VA 23666-6602

Mailing address

1233 23Rd St
Newport News, VA 23607-4801
Phone (772) 678-1397

Other practice location 1

1233 23rd St
Newport News, VA 23607-4801
Phone (772) 678-1397

Other practice location 2

2206 Executive Dr
Suite A
Hampton, VA 23666
Phone (772) 208-8773

Other identifiers 1

IdentifierTypeStateIssuer
4945573MedicaidVA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Palmer Springs Group Home Inc Mental Health Current Accepting new patients
Hampton Newport News Community Services Board PastSince Jan 8, 1996 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1237766400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691366400000",
    "number": "1013158963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1233 23RD ST",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236074801",
            "telephone_number": "772-678-1397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2204 EXECUTIVE DR",
            "address_2": "SUITE A",
            "city": "HAMPTON",
            "state": "VA",
            "postal_code": "236666602",
            "telephone_number": "757-644-3989",
            "fax_number": "866-813-7798"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1233 23rd St",
            "address_purpose": "LOCATION",
            "city": "Newport News",
            "state": "VA",
            "postal_code": "236074801",
            "country_code": "US",
            "telephone_number": "772-678-1397",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2206 Executive Dr",
            "address_2": "Suite A",
            "address_purpose": "LOCATION",
            "city": "Hampton",
            "state": "VA",
            "postal_code": "23666",
            "country_code": "US",
            "telephone_number": "772-208-8773",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LAURIEN",
        "first_name": "LETITIA",
        "middle_name": "N",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-03-23",
        "last_updated": "2023-08-07",
        "certification_date": "2023-08-04",
        "deactivation_date": "2023-07-17",
        "reactivation_date": "2023-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "SW16560",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "FL",
            "license": "SW16560",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904007077",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW16560",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4945573",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hampton, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.