Provider Demographics
NPI:1164055174
Name:MITCHELL, LAKEYA NICHOLE
Entity Type:Individual
Prefix:
First Name:LAKEYA
Middle Name:NICHOLE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2817 RYALS ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-1538
Mailing Address - Country:US
Mailing Address - Phone:912-208-0049
Mailing Address - Fax:
Practice Address - Street 1:351 COMMERCIAL DR STE A
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3618
Practice Address - Country:US
Practice Address - Phone:912-208-0049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC011315101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional