Healthcare Provider Details

I. General information

NPI: 1073021499
Provider Name (Legal Business Name): LAKEIA KIRKSEY MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2018
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7160 TCHULAHOMA RD BLDG B
SOUTHAVEN MS
38671-9266
US

IV. Provider business mailing address

885 FERNCLIFF CV STE 2
SOUTHAVEN MS
38671-2433
US

V. Phone/Fax

Practice location:
  • Phone: 662-536-3132
  • Fax:
Mailing address:
  • Phone: 662-856-3173
  • Fax: 662-470-5852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: