Provider Demographics
NPI:1083800247
Name:PADEN, LISA K (LCMHCS)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:K
Last Name:PADEN
Suffix:
Gender:F
Credentials:LCMHCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1736 DICKERSON BLVD # 142
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28110-2832
Mailing Address - Country:US
Mailing Address - Phone:704-931-8371
Mailing Address - Fax:
Practice Address - Street 1:16147 LANCASTER HWY STE 110
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-4196
Practice Address - Country:US
Practice Address - Phone:704-931-8371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-21
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7340101YP2500X
NCS7340101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional