Provider Demographics
NPI:1609161546
Name:BOOKER, TAKISHA ANDERSON (LPC)
Entity Type:Individual
Prefix:MRS
First Name:TAKISHA
Middle Name:ANDERSON
Last Name:BOOKER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:TAKISHA
Other - Middle Name:FENA
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3405 BLACK TOWER CT
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-8097
Mailing Address - Country:US
Mailing Address - Phone:910-813-7697
Mailing Address - Fax:
Practice Address - Street 1:1318 RAEFORD RD
Practice Address - Street 2:SUITE 1
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5482
Practice Address - Country:US
Practice Address - Phone:910-485-6336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-17
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA8234101YP2500X
NC8234101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional