Provider Demographics
NPI:1689554016
Name:FREEMAN, LEKISHIA LORRAINE (: 106S00000X)
Entity type:Individual
Prefix:
First Name:LEKISHIA
Middle Name:LORRAINE
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:: 106S00000X
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 SHADY LN
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-5000
Mailing Address - Country:US
Mailing Address - Phone:910-303-5065
Mailing Address - Fax:
Practice Address - Street 1:114 SHADY LN
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-5000
Practice Address - Country:US
Practice Address - Phone:910-303-5065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-05
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8436508106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty