Provider Demographics
NPI:1598563033
Name:EMBERY, LAKISHA (LISW-CP)
Entity type:Individual
Prefix:
First Name:LAKISHA
Middle Name:
Last Name:EMBERY
Suffix:
Gender:
Credentials:LISW-CP
Other - Prefix:
Other - First Name:LAKISHA
Other - Middle Name:
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:2301 ROBESON ST STE 103
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-5641
Mailing Address - Country:US
Mailing Address - Phone:910-273-3306
Mailing Address - Fax:
Practice Address - Street 1:2301 ROBESON ST STE 103
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5641
Practice Address - Country:US
Practice Address - Phone:910-273-3306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC166181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical