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General NPI Number Information
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NPI Number | 1497366892
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Entity Type | Individual
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Provider Name | LAKIA STALLINGS MMP, LMT
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Gender | Female
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Dates
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Enumeration Date | 08/11/2020
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Last Update Date | 09/29/2020
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Provider Practice Location Address
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Address Line | 751 THIMBLE SHOALS BLVD SUITE I
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-3563
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Country | US
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Telephone | 757-295-6234
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7972
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City | HAMPTON
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State | VA
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Zip | 23666-0972
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Country | US
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Telephone | 757-295-6234
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 0019015018
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License Number State | VA
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