Provider Demographics
NPI:1639512189
Name:COFFMAN, LAKENDRA DANIELLE (BSW)
Entity type:Individual
Prefix:
First Name:LAKENDRA
Middle Name:DANIELLE
Last Name:COFFMAN
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 NASHUA DR
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-6470
Mailing Address - Country:US
Mailing Address - Phone:832-640-1374
Mailing Address - Fax:281-677-4220
Practice Address - Street 1:2011 NASHUA DR
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-6470
Practice Address - Country:US
Practice Address - Phone:832-640-1374
Practice Address - Fax:281-677-4220
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-15
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities