Provider Demographics
NPI:1336435148
Name:WILSON, LAKISHA RENAE
Entity type:Individual
Prefix:MS
First Name:LAKISHA
Middle Name:RENAE
Last Name:WILSON
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 1:303 W WATER ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503-5627
Mailing Address - Country:US
Mailing Address - Phone:810-232-2766
Mailing Address - Fax:
Practice Address - Street 1:303 W WATER ST
Practice Address - Street 2:SUITE 108
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-5627
Practice Address - Country:US
Practice Address - Phone:810-232-2766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker