Provider Demographics
NPI:1114729738
Name:WILLIAMS, LAKISHA DANYA (MA, CHW, CLINIC MANA)
Entity type:Individual
Prefix:
First Name:LAKISHA
Middle Name:DANYA
Last Name:WILLIAMS
Suffix:
Gender:
Credentials:MA, CHW, CLINIC MANA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3940 NORTH MARTIN LUTHER KING BOULEVARD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032
Mailing Address - Country:US
Mailing Address - Phone:702-731-0909
Mailing Address - Fax:702-724-4978
Practice Address - Street 1:3940 NORTH MARTIN LUTHER KING BOULEVARD
Practice Address - Street 2:SUITE 110
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032
Practice Address - Country:US
Practice Address - Phone:702-731-0909
Practice Address - Fax:702-724-4978
Is Sole Proprietor?:No
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCHW1-6057172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker