Provider Demographics
NPI:1669882502
Name:WILLIAMS, LAKISHA (LMT)
Entity type:Individual
Prefix:MS
First Name:LAKISHA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 US HIGHWAY 22
Mailing Address - Street 2:SUITE 6B
Mailing Address - City:GREEN BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:08812-1756
Mailing Address - Country:US
Mailing Address - Phone:732-752-6606
Mailing Address - Fax:
Practice Address - Street 1:326 US HIGHWAY 22
Practice Address - Street 2:SUITE 6B
Practice Address - City:GREEN BROOK
Practice Address - State:NJ
Practice Address - Zip Code:08812-1756
Practice Address - Country:US
Practice Address - Phone:732-752-6606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-30
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT00596600225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ18KT00596600OtherNEW JERSEY BOARD OF MASSAGE AND BODYWORK THERAPY