Provider Demographics
NPI:1215350681
Name:RAYMON, LAKISHA
Entity type:Individual
Prefix:
First Name:LAKISHA
Middle Name:
Last Name:RAYMON
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 1:2106 CHICKASAW LOOP
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-9808
Mailing Address - Country:US
Mailing Address - Phone:803-493-4211
Mailing Address - Fax:
Practice Address - Street 1:2106 CHICKASAW LOOP
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-9808
Practice Address - Country:US
Practice Address - Phone:803-493-4211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-21
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9454101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional