Provider Demographics
NPI:1083986079
Name:ANTONISHEK, LISA (LLPC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:ANTONISHEK
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-1591
Mailing Address - Country:US
Mailing Address - Phone:810-227-6218
Mailing Address - Fax:
Practice Address - Street 1:324 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-1591
Practice Address - Country:US
Practice Address - Phone:810-227-6218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-06
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401011115101Y00000X
MI002318101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool