Healthcare Provider Details

I. General information

NPI: 1720727928
Provider Name (Legal Business Name): LAKEISHA THOMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2022
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 FLORETTA PL # 91251
RALEIGH NC
27676-9803
US

IV. Provider business mailing address

1 FLORETTA PL # 91251
RALEIGH NC
27676-9803
US

V. Phone/Fax

Practice location:
  • Phone: 919-228-9413
  • Fax:
Mailing address:
  • Phone: 919-228-9413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: