Provider Demographics
NPI:1750808523
Name:MOSLEY-DAVIS, LAKESHA (MS, NCC, LPC-S)
Entity type:Individual
Prefix:MRS
First Name:LAKESHA
Middle Name:
Last Name:MOSLEY-DAVIS
Suffix:
Gender:F
Credentials:MS, NCC, LPC-S
Other - Prefix:MRS
Other - First Name:LAKESHA
Other - Middle Name:D
Other - Last Name:MOSLEY-DAVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, NCC, LPC
Mailing Address - Street 1:7109 PINE OAK LN
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:LA
Mailing Address - Zip Code:71033-3377
Mailing Address - Country:US
Mailing Address - Phone:318-405-1382
Mailing Address - Fax:
Practice Address - Street 1:333 TEXAS ST, 1300 BOARDWALK BLVD
Practice Address - Street 2:1300 BOARDWALK BLVD
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104
Practice Address - Country:US
Practice Address - Phone:318-405-1382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-23
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7638101Y00000X, 101YM0800X, 101YP2500X
VA0701011208101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health