Healthcare Provider Details

I. General information

NPI: 1245617877
Provider Name (Legal Business Name): IIESHA LASHA RICKS LCSW, LCSW-C, PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2015
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

587 LEONARD LN
NEWPORT NEWS VA
23601-1757
US

IV. Provider business mailing address

8401 MAYLAND DR # 4467
HENRICO VA
23294-4648
US

V. Phone/Fax

Practice location:
  • Phone: 757-528-2016
  • Fax:
Mailing address:
  • Phone: 757-528-2016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0904015992
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: