Provider Demographics
NPI:1598958027
Name:GINN, LAKESHIA LAWAN (LCSW)
Entity Type:Individual
Prefix:
First Name:LAKESHIA
Middle Name:LAWAN
Last Name:GINN
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 1:10029 TREESIDE LN
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-7223
Mailing Address - Country:US
Mailing Address - Phone:980-348-9321
Mailing Address - Fax:
Practice Address - Street 1:810 TYVOLA RD
Practice Address - Street 2:STE 126
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-3592
Practice Address - Country:US
Practice Address - Phone:704-566-3410
Practice Address - Fax:704-537-1226
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-17
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0057561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical