Individual
IIESHA LASHA RICKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4445 CORPORATION LN STE 264, VIRGINIA BEACH, VA 23462-3262
(757) 528-2016
Mailing address
8401 MAYLAND DR # 4467, HENRICO, VA 23294-4648
(757) 528-2016
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
0904015992
VA
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A61716316
LICENSE
VA
Enumeration date
05/04/2015
Last updated
08/06/2024
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