Provider Demographics
NPI:1487837365
Name:BROOKS-LEAK, LAKESSIA RENEE (CSC-AD)
Entity Type:Individual
Prefix:MRS
First Name:LAKESSIA
Middle Name:RENEE
Last Name:BROOKS-LEAK
Suffix:
Gender:F
Credentials:CSC-AD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3749 BRICE RUN RD APT A
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-3826
Mailing Address - Country:US
Mailing Address - Phone:410-922-2161
Mailing Address - Fax:
Practice Address - Street 1:3749 BRICE RUN RD APT A
Practice Address - Street 2:
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-3826
Practice Address - Country:US
Practice Address - Phone:410-922-2161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-13
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDSC0879101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)