Provider Demographics
NPI:1316767718
Name:CRAWFORD, LAKISHIA (LMT, MMP)
Entity type:Individual
Prefix:
First Name:LAKISHIA
Middle Name:
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:LMT, MMP
Other - Prefix:
Other - First Name:KISHA
Other - Middle Name:
Other - Last Name:CRAWFORD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LM, MMP
Mailing Address - Street 1:3381 MALONE DR UNIT 314
Mailing Address - Street 2:
Mailing Address - City:CHAMBLEE
Mailing Address - State:GA
Mailing Address - Zip Code:30341-2777
Mailing Address - Country:US
Mailing Address - Phone:404-518-3440
Mailing Address - Fax:
Practice Address - Street 1:275 CARPENTER DR STE 209
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-4910
Practice Address - Country:US
Practice Address - Phone:404-518-3440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-11
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT008203225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist