Provider Demographics
NPI:1144731472
Name:GRANT, LAKESHIA (DOULA CERTIFICATION)
Entity type:Individual
Prefix:
First Name:LAKESHIA
Middle Name:
Last Name:GRANT
Suffix:
Gender:F
Credentials:DOULA CERTIFICATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17619 FAUST AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48219-3504
Mailing Address - Country:US
Mailing Address - Phone:313-957-9610
Mailing Address - Fax:
Practice Address - Street 1:17619 FAUST AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-3504
Practice Address - Country:US
Practice Address - Phone:313-957-9610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-13
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician