Provider Demographics
NPI:1124841077
Name:LECLERC, IVANA JEANNE (MS,LPCR)
Entity type:Individual
Prefix:MRS
First Name:IVANA
Middle Name:JEANNE
Last Name:LECLERC
Suffix:
Gender:F
Credentials:MS,LPCR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6014 EDGELAKE DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-4905
Mailing Address - Country:US
Mailing Address - Phone:570-800-3025
Mailing Address - Fax:
Practice Address - Street 1:1064 LASKIN RD STE 14C
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-6337
Practice Address - Country:US
Practice Address - Phone:757-233-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704017114101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional