Provider Demographics
NPI:1689977969
Name:BOGGAN, LAKEISHA TAMEIKA (LPC)
Entity Type:Individual
Prefix:
First Name:LAKEISHA
Middle Name:TAMEIKA
Last Name:BOGGAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:284 EXECUTIVE PARK DR.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-1894
Mailing Address - Country:US
Mailing Address - Phone:704-939-1000
Mailing Address - Fax:704-939-1173
Practice Address - Street 1:704 OLD LILESVILLE RD
Practice Address - Street 2:
Practice Address - City:WADESBORO
Practice Address - State:NC
Practice Address - Zip Code:28170-2820
Practice Address - Country:US
Practice Address - Phone:704-694-6588
Practice Address - Fax:704-694-6706
Is Sole Proprietor?:No
Enumeration Date:2010-12-08
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9959101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional