Provider Demographics
NPI:1639472350
Name:LIGHTY, LA KEISHA REAVES (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:LA KEISHA
Middle Name:REAVES
Last Name:LIGHTY
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 LONG PINE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH MILLS
Mailing Address - State:NC
Mailing Address - Zip Code:27976-9611
Mailing Address - Country:US
Mailing Address - Phone:252-339-1425
Mailing Address - Fax:
Practice Address - Street 1:121 LONG PINE RD
Practice Address - Street 2:
Practice Address - City:SOUTH MILLS
Practice Address - State:NC
Practice Address - Zip Code:27976-9611
Practice Address - Country:US
Practice Address - Phone:252-339-1425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-20
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0081431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical