Provider Demographics
NPI:1811503899
Name:CONQUEST, LAKESHIA (QMHP)
Entity type:Individual
Prefix:
First Name:LAKESHIA
Middle Name:
Last Name:CONQUEST
Suffix:
Gender:F
Credentials:QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 BANK ST
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-4524
Mailing Address - Country:US
Mailing Address - Phone:757-316-4414
Mailing Address - Fax:
Practice Address - Street 1:2005 OLD GREENBRIER RD STE 104
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2649
Practice Address - Country:US
Practice Address - Phone:757-210-4072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-16
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1477155612Medicaid
VA30015053770002Medicaid