Provider Demographics
NPI:1629535497
Name:ROBERTS, LAKEISHA LASHUN (BS)
Entity Type:Individual
Prefix:
First Name:LAKEISHA
Middle Name:LASHUN
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:BS
Other - Prefix:MRS
Other - First Name:LAKEISHA
Other - Middle Name:LASHUN
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BACHELOR'S
Mailing Address - Street 1:860 E RIVER PL STE 100
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-3442
Mailing Address - Country:US
Mailing Address - Phone:769-251-5550
Mailing Address - Fax:
Practice Address - Street 1:203 E OAK ST
Practice Address - Street 2:
Practice Address - City:AMITE
Practice Address - State:LA
Practice Address - Zip Code:70422-2817
Practice Address - Country:US
Practice Address - Phone:225-205-1824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-27
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor