Provider Demographics
NPI:1114534526
Name:WHITFELD, LAKEYSHER SWANTIMA
Entity Type:Individual
Prefix:
First Name:LAKEYSHER
Middle Name:SWANTIMA
Last Name:WHITFELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAKEYSHER
Other - Middle Name:
Other - Last Name:WHITFIELD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4023 MARINE AVE
Mailing Address - Street 2:
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260-1840
Mailing Address - Country:US
Mailing Address - Phone:310-679-9555
Mailing Address - Fax:213-263-1909
Practice Address - Street 1:4023 MARINE AVE
Practice Address - Street 2:
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-1840
Practice Address - Country:US
Practice Address - Phone:310-675-9555
Practice Address - Fax:310-675-9555
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-29
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB5663579101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty