Provider Demographics
NPI:1689220907
Name:GRANT, LAKEIA M (LMSW)
Entity Type:Individual
Prefix:MS
First Name:LAKEIA
Middle Name:M
Last Name:GRANT
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BANVOY MENTAL HEALTH COUNSELING, PLLC
Mailing Address - Street 2:466 E MAIN STREET
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-2516
Mailing Address - Country:US
Mailing Address - Phone:845-843-6400
Mailing Address - Fax:845-421-6804
Practice Address - Street 1:BANVOY MENTAL HEALTH COUNSELING, PLLC
Practice Address - Street 2:466 E MAIN STREET
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-2516
Practice Address - Country:US
Practice Address - Phone:845-843-6400
Practice Address - Fax:845-421-6804
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-13
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY106969-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker