Provider Demographics
NPI:1487720405
Name:COAKLEY, LAKESHIA EVETT
Entity type:Individual
Prefix:MS
First Name:LAKESHIA
Middle Name:EVETT
Last Name:COAKLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAKESHIA
Other - Middle Name:EVETT
Other - Last Name:COAKLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:8300 RIVERWIND LN
Mailing Address - Street 2:APT 108
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-8451
Mailing Address - Country:US
Mailing Address - Phone:919-790-8580
Mailing Address - Fax:
Practice Address - Street 1:3125 POPLARWOOD CT
Practice Address - Street 2:SUITE 304
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-1084
Practice Address - Country:US
Practice Address - Phone:919-790-8580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1487720405Medicaid