Provider Demographics
NPI:1215201470
Name:WRIGHT, LAKEYSA MARIE (LISW-CP)
Entity Type:Individual
Prefix:DR
First Name:LAKEYSA
Middle Name:MARIE
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 BURCALE RD APT F7
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-8315
Mailing Address - Country:US
Mailing Address - Phone:945-201-1878
Mailing Address - Fax:
Practice Address - Street 1:314A LAUREL ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-5157
Practice Address - Country:US
Practice Address - Phone:843-279-0172
Practice Address - Fax:843-438-4386
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-05
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040078411041C0700X
SC73341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical