Healthcare Provider Details

I. General information

NPI: 1578264776
Provider Name (Legal Business Name): LAKESHA ROBINSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2023
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

557 GRANTS FERRY RD
BRANDON MS
39047-9023
US

IV. Provider business mailing address

401 EITEL PL
BROOKHAVEN MS
39601-2403
US

V. Phone/Fax

Practice location:
  • Phone: 601-665-4162
  • Fax: 855-830-3484
Mailing address:
  • Phone: 601-455-6222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC10516
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: