Provider Demographics
NPI:1093004087
Name:LIDDELL, LAKESHA RENEA (MS, LPC -IT)
Entity Type:Individual
Prefix:
First Name:LAKESHA
Middle Name:RENEA
Last Name:LIDDELL
Suffix:
Gender:F
Credentials:MS, LPC -IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8624 W GREEN BROOK DR
Mailing Address - Street 2:LOWER
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53224-2127
Mailing Address - Country:US
Mailing Address - Phone:414-426-5266
Mailing Address - Fax:
Practice Address - Street 1:8624 W GREEN BROOK DR
Practice Address - Street 2:LOWER
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53224-2127
Practice Address - Country:US
Practice Address - Phone:414-426-5266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-30
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health