Provider Demographics
NPI:1093118556
Name:STINSON, LISA (MBA)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:STINSON
Suffix:
Gender:F
Credentials:MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1288 VINTAGE POINTE DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-3277
Mailing Address - Country:US
Mailing Address - Phone:770-921-7655
Mailing Address - Fax:770-921-0684
Practice Address - Street 1:1288 VINTAGE POINTE DR
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-3277
Practice Address - Country:US
Practice Address - Phone:770-921-7655
Practice Address - Fax:770-921-0684
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-29
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health