Provider Demographics
NPI:1770335838
Name:TERRY, KIA LASHEKA
Entity type:Individual
Prefix:
First Name:KIA
Middle Name:LASHEKA
Last Name:TERRY
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 1:2711 RADFORD ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22302-2615
Mailing Address - Country:US
Mailing Address - Phone:202-948-7140
Mailing Address - Fax:
Practice Address - Street 1:2711 RADFORD ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22302-2615
Practice Address - Country:US
Practice Address - Phone:202-948-7140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator