Provider Demographics
NPI:1033910799
Name:ROQUEMORE, LAKEISHA (LCDC)
Entity type:Individual
Prefix:
First Name:LAKEISHA
Middle Name:
Last Name:ROQUEMORE
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 GATEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WHITEHOUSE
Mailing Address - State:TX
Mailing Address - Zip Code:75791-3323
Mailing Address - Country:US
Mailing Address - Phone:903-941-3069
Mailing Address - Fax:
Practice Address - Street 1:1411 S BENNETT AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-2506
Practice Address - Country:US
Practice Address - Phone:903-535-7314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-20
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17046101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)