Provider Demographics
NPI:1790068807
Name:WITHERSPOON, LAKISHA THERESA (LICSW)
Entity Type:Individual
Prefix:MS
First Name:LAKISHA
Middle Name:THERESA
Last Name:WITHERSPOON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:LAKISHA
Other - Middle Name:THERESA
Other - Last Name:SUTTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 BRYANT ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-1708
Mailing Address - Country:US
Mailing Address - Phone:202-939-3610
Mailing Address - Fax:202-671-0086
Practice Address - Street 1:4301 13TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-5629
Practice Address - Country:US
Practice Address - Phone:202-576-8399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-25
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500790321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical