Provider Demographics
NPI:1487199477
Name:BROWN, LAKEISHA (LCSW, LCAS, LPCA)
Entity Type:Individual
Prefix:
First Name:LAKEISHA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:LCSW, LCAS, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 ALEXANDRIA LN
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-9494
Mailing Address - Country:US
Mailing Address - Phone:252-717-7782
Mailing Address - Fax:
Practice Address - Street 1:704 ALEXANDRIA LN
Practice Address - Street 2:
Practice Address - City:WINTERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28590-9494
Practice Address - Country:US
Practice Address - Phone:252-717-7782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-29
Last Update Date:2020-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20604101YA0400X
NCA13559101YP2500X
NCC0117391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC20604OtherLICENSED CLINICAL ADDICTION SPECIALIST-ASSOCIATE
NCC011739OtherLICENSED CLINICAL SOCIAL WORKER
NCA13559OtherNCBLPC