Provider Demographics
NPI:1891240396
Name:GRANT, LAKESHIA (LPC)
Entity Type:Individual
Prefix:MS
First Name:LAKESHIA
Middle Name:
Last Name:GRANT
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 1:4554 GLENWICK LN APT 3104
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-4639
Mailing Address - Country:US
Mailing Address - Phone:469-658-6062
Mailing Address - Fax:
Practice Address - Street 1:6301 GASTON AVE STE 1408
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-3963
Practice Address - Country:US
Practice Address - Phone:468-865-8614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-24
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69879101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional