1811976426 NPI number — LECCI PSYCHOLOGICAL SERVICES, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811976426 NPI number — LECCI PSYCHOLOGICAL SERVICES, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LECCI PSYCHOLOGICAL SERVICES, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811976426
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/26/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
219 RACINE DR STE B
Provider Second Line Business Mailing Address:
MARS MEMORY HEALTH NETWORK
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28403-8828
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-791-6277
Provider Business Mailing Address Fax Number:
910-791-6226

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
219 RACINE DR STE B
Provider Second Line Business Practice Location Address:
MARS MEMORY HEALTH NETWORK
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28403-8828
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-791-6277
Provider Business Practice Location Address Fax Number:
910-791-6226
Provider Enumeration Date:
01/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LECCI
Authorized Official First Name:
LEN
Authorized Official Middle Name:
B
Authorized Official Title or Position:
OWNER AND MANAGER
Authorized Official Telephone Number:
910-962-7262

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  3041 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 017HY . This is a "BC BS FOR MARS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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