Provider Demographics
NPI:1760285456
Name:RICKS, LENASIA DEVINE
Entity type:Individual
Prefix:
First Name:LENASIA
Middle Name:DEVINE
Last Name:RICKS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7147 SEWELLS POINT RD APT G
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23513-1844
Mailing Address - Country:US
Mailing Address - Phone:757-990-0921
Mailing Address - Fax:
Practice Address - Street 1:7147 SEWELLS POINT RD APT G
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23513-1844
Practice Address - Country:US
Practice Address - Phone:757-990-0921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-29
Last Update Date:2025-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA19018521225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist