Provider Demographics
NPI:1275966699
Name:SUMRALL-CARR, LAKESHIA MARIE (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:LAKESHIA
Middle Name:MARIE
Last Name:SUMRALL-CARR
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9128 S TROY AVE
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-1628
Mailing Address - Country:US
Mailing Address - Phone:773-793-3386
Mailing Address - Fax:
Practice Address - Street 1:9128 S TROY AVE
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-1628
Practice Address - Country:US
Practice Address - Phone:773-793-3386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180007546101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor