Provider Demographics
NPI:1720885411
Name:KINCAID, LEESHIRA NICOLE
Entity type:Individual
Prefix:
First Name:LEESHIRA
Middle Name:NICOLE
Last Name:KINCAID
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1744 POPE AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23509-1040
Mailing Address - Country:US
Mailing Address - Phone:256-616-6460
Mailing Address - Fax:
Practice Address - Street 1:1108 EDEN WAY N
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-3339
Practice Address - Country:US
Practice Address - Phone:708-596-9332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician