Provider Demographics
NPI:1962646927
Name:IZZARD, LAKLIESHIA MONIQUE (LPC)
Entity Type:Individual
Prefix:MS
First Name:LAKLIESHIA
Middle Name:MONIQUE
Last Name:IZZARD
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:PO BOX 33082
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-0082
Mailing Address - Country:US
Mailing Address - Phone:678-683-8194
Mailing Address - Fax:
Practice Address - Street 1:4319 COVINGTON HWY
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035-1210
Practice Address - Country:US
Practice Address - Phone:404-284-6505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-21
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006858101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional