Provider Demographics
NPI:1447753157
Name:HAMPTON MITCHELL, LAKIESHA (LCSW)
Entity Type:Individual
Prefix:
First Name:LAKIESHA
Middle Name:
Last Name:HAMPTON MITCHELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4098 ROBIN CIR
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30349-1663
Mailing Address - Country:US
Mailing Address - Phone:678-509-4566
Mailing Address - Fax:
Practice Address - Street 1:4405 MALL BLVD STE 110-C
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:GA
Practice Address - Zip Code:30291-2044
Practice Address - Country:US
Practice Address - Phone:470-685-7470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-09
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007087104100000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial Worker