Provider Demographics
NPI:1083954192
Name:TAIT, LISA MONETTE (LPC)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:MONETTE
Last Name:TAIT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:LMT
Other - Middle Name:
Other - Last Name:ENTERPRISES, LLC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, DMIN
Mailing Address - Street 1:5238 ASHLEY DR SW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-6639
Mailing Address - Country:US
Mailing Address - Phone:770-356-0101
Mailing Address - Fax:770-925-0305
Practice Address - Street 1:5238 ASHLEY DR SW
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-6639
Practice Address - Country:US
Practice Address - Phone:770-356-0101
Practice Address - Fax:770-925-0305
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-26
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007320101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional