Provider Demographics
NPI:1386388965
Name:CRAWFORD, LAKEYSHA
Entity type:Individual
Prefix:
First Name:LAKEYSHA
Middle Name:
Last Name:CRAWFORD
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 1:5193 PEACHTREE BLVD APT 2302
Mailing Address - Street 2:
Mailing Address - City:CHAMBLEE
Mailing Address - State:GA
Mailing Address - Zip Code:30341-3158
Mailing Address - Country:US
Mailing Address - Phone:404-817-6439
Mailing Address - Fax:
Practice Address - Street 1:3850 HOLCOMB BRIDGE RD
Practice Address - Street 2:
Practice Address - City:PEACHTREE CORNERS
Practice Address - State:GA
Practice Address - Zip Code:30092-5223
Practice Address - Country:US
Practice Address - Phone:470-361-2462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-21
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician