Provider Demographics
NPI:1194170498
Name:SMITH, LAKEISHA D (LPC)
Entity type:Individual
Prefix:
First Name:LAKEISHA
Middle Name:D
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:LAKEISHA
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:7000 ROSWELL RD APT 352
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-2395
Mailing Address - Country:US
Mailing Address - Phone:678-348-0430
Mailing Address - Fax:
Practice Address - Street 1:2496 JETT FERRY RD STE 204
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-3061
Practice Address - Country:US
Practice Address - Phone:678-348-0430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-25
Last Update Date:2020-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC008022101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health