Provider Demographics
NPI:1942086681
Name:MASSEY, LAKEYIA SHANISE
Entity Type:Individual
Prefix:
First Name:LAKEYIA
Middle Name:SHANISE
Last Name:MASSEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 TIMBER VALLEY WAY STE 107
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-5375
Mailing Address - Country:US
Mailing Address - Phone:619-846-8805
Mailing Address - Fax:
Practice Address - Street 1:905 TIMBER VALLEY WAY STE 107
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-5375
Practice Address - Country:US
Practice Address - Phone:619-846-8805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040157561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical