Provider Demographics
NPI:1780498931
Name:SMITH, LAKIRA (EDS)
Entity type:Individual
Prefix:
First Name:LAKIRA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4420 TANEY AVE APT 204
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-6932
Mailing Address - Country:US
Mailing Address - Phone:732-832-6393
Mailing Address - Fax:
Practice Address - Street 1:540 55TH ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-6799
Practice Address - Country:US
Practice Address - Phone:202-939-2030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-06
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDC5418556448103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool