Provider Demographics
NPI:1255445714
Name:RICCIO-HUCK, DONNELLE JUNE (MS, LPC)
Entity type:Individual
Prefix:MRS
First Name:DONNELLE
Middle Name:JUNE
Last Name:RICCIO-HUCK
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:DONNELLE
Other - Middle Name:
Other - Last Name:RICCIO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2697 INTERNATIONAL PKWY STE 107
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-7803
Mailing Address - Country:US
Mailing Address - Phone:757-689-2680
Mailing Address - Fax:757-689-2681
Practice Address - Street 1:2697 INTERNATIONAL PKWY STE 107
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7803
Practice Address - Country:US
Practice Address - Phone:757-689-2680
Practice Address - Fax:757-689-2681
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002825101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010127149Medicaid