Provider Demographics
NPI:1689049835
Name:GILBERT, LAKESHIA
Entity Type:Individual
Prefix:MRS
First Name:LAKESHIA
Middle Name:
Last Name:GILBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 CLEARLAKE CT
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-3436
Mailing Address - Country:US
Mailing Address - Phone:410-661-0535
Mailing Address - Fax:
Practice Address - Street 1:1001 CROMWELL BRIDGE RD
Practice Address - Street 2:SUITE 212
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-3300
Practice Address - Country:US
Practice Address - Phone:410-337-5523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-14
Last Update Date:2016-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC7415101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional