Healthcare Provider Details

I. General information

NPI: 1063797256
Provider Name (Legal Business Name): LAKESHA MITCHELL BARRETT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2011
Last Update Date: 10/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5002 MONUMENT AVE SUITE 201
RICHMOND VA
23230-3634
US

IV. Provider business mailing address

5002 MONUMENT AVE SUITE 201
RICHMOND VA
23230-3634
US

V. Phone/Fax

Practice location:
  • Phone: 804-543-1388
  • Fax: 804-497-4677
Mailing address:
  • Phone: 804-543-1388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904007626
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: