Healthcare Provider Details

I. General information

NPI: 1609578475
Provider Name (Legal Business Name): LAKISHA WOMACK LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2023
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date: 09/11/2026
Reactivation Date: 09/16/2026

III. Provider practice location address

300 51ST ST SE
WASHINGTON DC
20019-6301
US

IV. Provider business mailing address

PO BOX 914
CHATHAM VA
24531-0914
US

V. Phone/Fax

Practice location:
  • Phone: 202-743-5656
  • Fax:
Mailing address:
  • Phone: 202-271-6655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPRC200002418
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number200001494
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number200001494
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: