Provider Demographics
NPI:1831646454
Name:SPIVEY-KENNEDY, RICKIA IZETTA (MED)
Entity Type:Individual
Prefix:MS
First Name:RICKIA
Middle Name:IZETTA
Last Name:SPIVEY-KENNEDY
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:RICKIA
Other - Middle Name:IZETTA
Other - Last Name:SPIVEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED
Mailing Address - Street 1:36 AVIGNON DRIVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702
Mailing Address - Country:US
Mailing Address - Phone:302-604-2155
Mailing Address - Fax:
Practice Address - Street 1:36 AVIGNON DRIVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702
Practice Address - Country:US
Practice Address - Phone:302-604-2155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health