Provider Demographics
NPI:1063501450
Name:ANGER, LISA BETH (LCSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:BETH
Last Name:ANGER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:BETH
Other - Last Name:WURZBURG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSW
Mailing Address - Street 1:160 TIMBERLANE DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2400
Mailing Address - Country:US
Mailing Address - Phone:706-540-6249
Mailing Address - Fax:
Practice Address - Street 1:500 N MILLEDGE AVE
Practice Address - Street 2:SUITE 219
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30601-3810
Practice Address - Country:US
Practice Address - Phone:706-540-6249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA24741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA833623732AMedicaid
GA80BBFXWMedicare ID - Type Unspecified
GA833623732AMedicaid