Provider Demographics
NPI:1386963957
Name:VARNER, LAKEISHA (LPC, CPCS)
Entity type:Individual
Prefix:
First Name:LAKEISHA
Middle Name:
Last Name:VARNER
Suffix:
Gender:F
Credentials:LPC, CPCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5861 CREEKSIDE DR # 500
Mailing Address - Street 2:
Mailing Address - City:REX
Mailing Address - State:GA
Mailing Address - Zip Code:30273-1182
Mailing Address - Country:US
Mailing Address - Phone:678-849-4271
Mailing Address - Fax:
Practice Address - Street 1:5861 CREEKSIDE DR # 500
Practice Address - Street 2:
Practice Address - City:REX
Practice Address - State:GA
Practice Address - Zip Code:30273-1182
Practice Address - Country:US
Practice Address - Phone:678-849-4271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-21
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC002408101YP2500X
GALPC06967101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003152492AMedicaid