Provider Demographics
NPI:1942394564
Name:LESA LACKEY DOAN,P.A.
Entity Type:Organization
Organization Name:LESA LACKEY DOAN,P.A.
Other - Org Name:THE FAMILY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESA
Authorized Official - Middle Name:LACKEY
Authorized Official - Last Name:DOAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:501-221-2811
Mailing Address - Street 1:11215 HERMITAGE ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211
Mailing Address - Country:US
Mailing Address - Phone:501-221-2811
Mailing Address - Fax:501-221-2812
Practice Address - Street 1:11215 HERMITAGE ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211
Practice Address - Country:US
Practice Address - Phone:501-221-2811
Practice Address - Fax:501-221-2812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC-574101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1033147111OtherNPI INDIVIDUAL IDENTIFIER
AR5S205Medicare ID - Type Unspecified