Provider Demographics
NPI:1639525801
Name:DR. NAKIETA M. LANKSTER LLC
Entity Type:Organization
Organization Name:DR. NAKIETA M. LANKSTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NAKIETA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LANKSTER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:202-838-6455
Mailing Address - Street 1:2119 167TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-1524
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:108 W CAPITOL ST
Practice Address - Street 2:
Practice Address - City:DEMOPOLIS
Practice Address - State:AL
Practice Address - Zip Code:36732-2002
Practice Address - Country:US
Practice Address - Phone:202-838-6455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-06
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2010251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health