Healthcare Provider Details

I. General information

NPI: 1154165967
Provider Name (Legal Business Name): MRS. LAKESHA SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2024
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2255 CRAIN HWY STE 105
WALDORF MD
20601-3186
US

IV. Provider business mailing address

2255 CRAIN HWY. SUITE 105 OFFICES 1-13 &1-15
WALDORF MD
20601-3186
US

V. Phone/Fax

Practice location:
  • Phone: 443-648-0744
  • Fax:
Mailing address:
  • Phone: 443-648-0744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: