Healthcare Provider Details

I. General information

NPI: 1518436799
Provider Name (Legal Business Name): MS. LAKISHA BRATCHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2018
Last Update Date: 11/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 M ST NW STE 200
WASHINGTON DC
20005-5225
US

IV. Provider business mailing address

11139 SOUTHPORT PL
WHITE PLAINS MD
20695-4144
US

V. Phone/Fax

Practice location:
  • Phone: 202-706-7603
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC50080566
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: