Provider Demographics
NPI:1548018856
Name:HARRIS, LAKISHA (RBT)
Entity type:Individual
Prefix:
First Name:LAKISHA
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:763 J CLYDE MORRIS BLVD STE 1C
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1533
Mailing Address - Country:US
Mailing Address - Phone:577-524-2510
Mailing Address - Fax:
Practice Address - Street 1:763 J CLYDE MORRIS BLVD STE 1C
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-1533
Practice Address - Country:US
Practice Address - Phone:757-524-2510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician