Provider Demographics
NPI:1194691147
Name:CHARLES, LAKEISHA LYNETTE
Entity type:Individual
Prefix:
First Name:LAKEISHA
Middle Name:LYNETTE
Last Name:CHARLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2214 PRAIRIE FOREST TRL
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77373-2303
Mailing Address - Country:US
Mailing Address - Phone:832-404-3100
Mailing Address - Fax:
Practice Address - Street 1:11767 KATY FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-1716
Practice Address - Country:US
Practice Address - Phone:832-404-3100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-16
Last Update Date:2025-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator