Provider Demographics
NPI:1699126516
Name:FAIR, LAKEISHA
Entity type:Individual
Prefix:
First Name:LAKEISHA
Middle Name:
Last Name:FAIR
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 1:722 OXFORD RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:LA
Mailing Address - Zip Code:71052-5015
Mailing Address - Country:US
Mailing Address - Phone:318-507-8077
Mailing Address - Fax:318-213-0905
Practice Address - Street 1:722 OXFORD RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:LA
Practice Address - Zip Code:71052
Practice Address - Country:US
Practice Address - Phone:318-507-8077
Practice Address - Fax:318-213-0905
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-22
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor