Provider Demographics
NPI:1316680416
Name:TERRY, LAKESHIA MICHELLE (LPC)
Entity type:Individual
Prefix:MRS
First Name:LAKESHIA
Middle Name:MICHELLE
Last Name:TERRY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6334 SAINT ANDREWS RD STE 2
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-3143
Mailing Address - Country:US
Mailing Address - Phone:803-764-0961
Mailing Address - Fax:803-764-4089
Practice Address - Street 1:6334 SAINT ANDREWS RD STE 103
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29212-3143
Practice Address - Country:US
Practice Address - Phone:803-764-0961
Practice Address - Fax:803-764-4089
Is Sole Proprietor?:No
Enumeration Date:2022-04-16
Last Update Date:2022-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8241101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP7008Medicaid