Provider Demographics
NPI:1144692773
Name:FRYE, LAKISIA
Entity type:Individual
Prefix:
First Name:LAKISIA
Middle Name:
Last Name:FRYE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 EE WALLACE BLVD S
Mailing Address - Street 2:
Mailing Address - City:FERRIDAY
Mailing Address - State:LA
Mailing Address - Zip Code:71334-3224
Mailing Address - Country:US
Mailing Address - Phone:318-757-9363
Mailing Address - Fax:318-757-9364
Practice Address - Street 1:615 EE WALLACE BLVD
Practice Address - Street 2:
Practice Address - City:FERRIDAY
Practice Address - State:LA
Practice Address - Zip Code:71334
Practice Address - Country:US
Practice Address - Phone:318-757-9363
Practice Address - Fax:318-757-9364
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-22
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 171M00000X
LAPLC9448101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator