Provider Demographics
NPI:1649080516
Name:FREEMAN, LAKISHIA R
Entity type:Individual
Prefix:
First Name:LAKISHIA
Middle Name:R
Last Name:FREEMAN
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 1:15311 EDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44137-3903
Mailing Address - Country:US
Mailing Address - Phone:216-338-9097
Mailing Address - Fax:
Practice Address - Street 1:11806 RUTLAND AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44108-1538
Practice Address - Country:US
Practice Address - Phone:216-338-9097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSA245164172A00000X
OH002403172V00000X
OH186671101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No172A00000XOther Service ProvidersDriver
No172V00000XOther Service ProvidersCommunity Health Worker