Provider Demographics
NPI:1366954265
Name:WHITE, LAKESHIA (LLMSW)
Entity type:Individual
Prefix:
First Name:LAKESHIA
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:LAKESHIA
Other - Middle Name:
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LLMSW
Mailing Address - Street 1:26901 BEAUMONT BLVD STE 3D
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3849
Mailing Address - Country:US
Mailing Address - Phone:947-522-1848
Mailing Address - Fax:947-522-0307
Practice Address - Street 1:9650 WAYNE RD
Practice Address - Street 2:
Practice Address - City:ROMULUS
Practice Address - State:MI
Practice Address - Zip Code:48174-1551
Practice Address - Country:US
Practice Address - Phone:734-942-4857
Practice Address - Fax:734-942-6734
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-01
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
MI68511169391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician