Provider Demographics
NPI:1619681038
Name:WEAVER, LAKENDRA SHARDAE (LPC-A)
Entity Type:Individual
Prefix:
First Name:LAKENDRA
Middle Name:SHARDAE
Last Name:WEAVER
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 BOTHAM JEAN BLVD APT 1234
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75215-1032
Mailing Address - Country:US
Mailing Address - Phone:214-842-5561
Mailing Address - Fax:
Practice Address - Street 1:4683 BETTS DR STE 403
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-1807
Practice Address - Country:US
Practice Address - Phone:214-842-5561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX89920101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health