Healthcare Provider Details

I. General information

NPI: 1710775168
Provider Name (Legal Business Name): LAKEISHA NICOLE TODD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2025
Last Update Date: 04/28/2025
Certification Date: 04/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 PRINCE WILLIAM PKWY STE 301
WOODBRIDGE VA
22192-7667
US

IV. Provider business mailing address

4024 CRESSIDA PL
WOODBRIDGE VA
22192-7631
US

V. Phone/Fax

Practice location:
  • Phone: 703-688-8541
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: