Provider Demographics
NPI:1497366892
Name:STALLINGS, LAKIA (MMP, LMT)
Entity Type:Individual
Prefix:
First Name:LAKIA
Middle Name:
Last Name:STALLINGS
Suffix:
Gender:F
Credentials:MMP, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7972
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-0972
Mailing Address - Country:US
Mailing Address - Phone:757-295-6234
Mailing Address - Fax:
Practice Address - Street 1:751 THIMBLE SHOALS BLVD
Practice Address - Street 2:SUITE I
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-3563
Practice Address - Country:US
Practice Address - Phone:757-295-6234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-11
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019015018225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist