Provider Demographics
NPI:1053607911
Name:RICKETTS, VIRGINIA (LCPC)
Entity type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:
Last Name:RICKETTS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8028 RITCHIE HWY
Mailing Address - Street 2:SUITE 308
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-1075
Mailing Address - Country:US
Mailing Address - Phone:410-761-0725
Mailing Address - Fax:410-761-2412
Practice Address - Street 1:8028 RITCHIE HWY
Practice Address - Street 2:SUITE 308
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-1075
Practice Address - Country:US
Practice Address - Phone:410-761-0725
Practice Address - Fax:410-761-2412
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC4000101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional