Provider Demographics
NPI:1225349681
Name:MCKNABB, LAKEISHA SHAMONE (LCMHCS, LCAS, CCS)
Entity Type:Individual
Prefix:
First Name:LAKEISHA
Middle Name:SHAMONE
Last Name:MCKNABB
Suffix:
Gender:F
Credentials:LCMHCS, LCAS, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 E LONG AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-2543
Mailing Address - Country:US
Mailing Address - Phone:704-594-1454
Mailing Address - Fax:
Practice Address - Street 1:436 E LONG AVE STE 1
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2543
Practice Address - Country:US
Practice Address - Phone:704-594-1454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-30
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22657101YA0400X
NC9712101YM0800X, 101YP2500X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health