Healthcare Provider Details

I. General information

NPI: 1083397137
Provider Name (Legal Business Name): LEKESHA RENEE' WYSE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LEKESHA RENEE' ANDREWS

II. Dates (important events)

Enumeration Date: 08/07/2023
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7475 HALCYON POINTE DR
MONTGOMERY AL
36117-8053
US

IV. Provider business mailing address

10637 HARCOURT TRCE
MONTGOMERY AL
36117-6074
US

V. Phone/Fax

Practice location:
  • Phone: 334-954-6010
  • Fax:
Mailing address:
  • Phone: 334-301-4586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC04913
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: