Provider Demographics
NPI:1164127692
Name:MORENO, LAKEYCHA SHERICE (LMSW)
Entity Type:Individual
Prefix:
First Name:LAKEYCHA
Middle Name:SHERICE
Last Name:MORENO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9737 AMBERTON PKWY APT 1065
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-2010
Mailing Address - Country:US
Mailing Address - Phone:517-763-7318
Mailing Address - Fax:
Practice Address - Street 1:9737 AMBERTON PKWY APT 1065
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-2010
Practice Address - Country:US
Practice Address - Phone:517-763-7318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106685104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker