Individual
MRS. NINA CONSALVI LACKEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC, CSAC
Contact information
Practice address
6767 FOREST HILL AVE, SUITE #306, RICHMOND, VA 23225
(804) 840-5457
Mailing address
14201 CAMACK TRL., MIDLOTHIAN, VA 23114
(804) 840-5457
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
VA
101YM0800X
Mental Health Counselor
Primary
0701001911
VA
Other
Enumeration date
08/08/2008
Last updated
08/08/2008
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