Lakisha Latrell Medina, is a
Social Worker - Clinical based in Fayetteville, North Carolina. Lakisha Latrell Medina is licensed to practice in North Carolina (license number P021173) and her current practice location is
1310 Raeford Rd Ste 1, Fayetteville, North Carolina. She can be reached at her office (for appointments etc.) via phone at
(910) 485-6336.
NPI number for Lakisha Latrell Medina is 1578382701 and her current mailing address is 4739 Ritson Ln, Fayetteville, North Carolina. She
does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1578382701.
Healthcare Provider's Profile
Full Name | Lakisha Latrell Medina |
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Gender | Female |
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Speciality | Social Worker - Clinical |
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Location | 1310 Raeford Rd Ste 1, Fayetteville, North Carolina |
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Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
NPI Data:
- NPI Number: 1578382701
- Provider Enumeration Date: 10/04/2024
- Last Update Date: 10/04/2024
Medical Identifiers
Medical identifiers for Lakisha Latrell Medina such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1578382701 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
101YA0400X | Counselor - Addiction (substance Use Disorder) | 30141 (North Carolina) | Secondary |
1041C0700X | Social Worker - Clinical | P021173 (North Carolina) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Lakisha Latrell Medina is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Lakisha Latrell Medina, 4739 Ritson Ln, Fayetteville, NC 28306-9751 Ph: (334) 520-7463 | Lakisha Latrell Medina, 1310 Raeford Rd Ste 1, Fayetteville, NC 28305-5086 Ph: (910) 485-6336 |
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