Provider Demographics
NPI:1962021352
Name:BURGESS, LAKEISHA CERESE
Entity Type:Individual
Prefix:
First Name:LAKEISHA
Middle Name:CERESE
Last Name:BURGESS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3618 ASHLEY PHOSPHATE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29418-8585
Mailing Address - Country:US
Mailing Address - Phone:843-459-2619
Mailing Address - Fax:843-459-2769
Practice Address - Street 1:3618 ASHLEY PHOSPHATE RD
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29418-8585
Practice Address - Country:US
Practice Address - Phone:843-459-2619
Practice Address - Fax:843-459-2769
Is Sole Proprietor?:No
Enumeration Date:2020-04-15
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator