Provider Demographics
NPI:1063961084
Name:BOYKIN, LAKISHA PATRICE (LPCA)
Entity type:Individual
Prefix:MRS
First Name:LAKISHA
Middle Name:PATRICE
Last Name:BOYKIN
Suffix:
Gender:F
Credentials:LPCA
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Other - First Name:
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Mailing Address - Street 1:284 EXECUTIVE PARK DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-1833
Mailing Address - Country:US
Mailing Address - Phone:704-939-1100
Mailing Address - Fax:704-939-1173
Practice Address - Street 1:725 N HIGHLAND AVE
Practice Address - Street 2:UNIT 100
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-4180
Practice Address - Country:US
Practice Address - Phone:336-607-8523
Practice Address - Fax:336-773-0916
Is Sole Proprietor?:No
Enumeration Date:2016-10-03
Last Update Date:2017-08-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NCA11337101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1063961084Medicaid
NC19PC2OtherBCBS