Provider Demographics
NPI:1447754288
Name:ASHFORD, LAKISHA MARTESA (CERTIFIED HAIR LOSS)
Entity Type:Individual
Prefix:
First Name:LAKISHA
Middle Name:MARTESA
Last Name:ASHFORD
Suffix:
Gender:F
Credentials:CERTIFIED HAIR LOSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 SAINT ANDREWS RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-5112
Mailing Address - Country:US
Mailing Address - Phone:800-719-0061
Mailing Address - Fax:
Practice Address - Street 1:651 SAINT ANDREWS RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-5112
Practice Address - Country:US
Practice Address - Phone:800-719-0061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC555481744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty