Provider Demographics
NPI:1508410382
Name:KEY, RICKY LEE SR
Entity Type:Individual
Prefix:
First Name:RICKY
Middle Name:LEE
Last Name:KEY
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1664 TETON CT
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-3888
Mailing Address - Country:US
Mailing Address - Phone:757-597-1799
Mailing Address - Fax:
Practice Address - Street 1:KALEIDOSCOPE COUNSELING AND CASE MANAGEMENT
Practice Address - Street 2:1712 AIRLINE BLVD
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707
Practice Address - Country:US
Practice Address - Phone:757-535-9153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health