Provider Demographics
NPI:1104656776
Name:WILLIAMS, LAKAN NICHOLE (ISC)
Entity type:Individual
Prefix:
First Name:LAKAN
Middle Name:NICHOLE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:ISC
Other - Prefix:
Other - First Name:LAKAN
Other - Middle Name:NICHOLE
Other - Last Name:NEWMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2345 MAPLE ACRES RD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24739-7361
Mailing Address - Country:US
Mailing Address - Phone:304-888-3152
Mailing Address - Fax:
Practice Address - Street 1:1411 N WALKER ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2636
Practice Address - Country:US
Practice Address - Phone:304-425-2926
Practice Address - Fax:304-425-7367
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency