Provider Demographics
NPI:1184296261
Name:GLENN, LEKISHA YVETTE (MS, NCC, LAPC)
Entity type:Individual
Prefix:
First Name:LEKISHA
Middle Name:YVETTE
Last Name:GLENN
Suffix:
Gender:
Credentials:MS, NCC, LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 FLEETWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30238-7823
Mailing Address - Country:US
Mailing Address - Phone:167-891-4151
Mailing Address - Fax:
Practice Address - Street 1:1396 SOUTHLAKE PLAZA DR
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-1756
Practice Address - Country:US
Practice Address - Phone:770-473-2592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-16
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC015332101YP2500X
GAAPC009034101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional