Provider Demographics
NPI:1114694908
Name:ANDROVICH, LISA MARIE (LMFT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:ANDROVICH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:971 VIA TREVISO
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-7246
Mailing Address - Country:US
Mailing Address - Phone:530-919-3969
Mailing Address - Fax:
Practice Address - Street 1:3430 ROBIN LN # 4
Practice Address - Street 2:
Practice Address - City:CAMERON PARK
Practice Address - State:CA
Practice Address - Zip Code:95682-8407
Practice Address - Country:US
Practice Address - Phone:530-676-2899
Practice Address - Fax:530-387-6456
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-27
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA127472106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist