Provider Demographics
NPI:1457843641
Name:MANN, LAKEESHA NICOLE
Entity Type:Individual
Prefix:
First Name:LAKEESHA
Middle Name:NICOLE
Last Name:MANN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7611 COPPERMINE DR
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-2668
Mailing Address - Country:US
Mailing Address - Phone:703-496-7804
Mailing Address - Fax:
Practice Address - Street 1:7611 COPPERMINE DR
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-2668
Practice Address - Country:US
Practice Address - Phone:703-496-7804
Practice Address - Fax:571-359-6784
Is Sole Proprietor?:No
Enumeration Date:2018-06-04
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133002199103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst