Provider Demographics
NPI:1124566336
Name:MARGRAVES, LISA A
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:MARGRAVES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:A
Other - Last Name:MARGRAVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:109 W 7TH ST
Mailing Address - Street 2:SUITE 235
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-5763
Mailing Address - Country:US
Mailing Address - Phone:512-788-5634
Mailing Address - Fax:
Practice Address - Street 1:109 W 7TH ST
Practice Address - Street 2:SUITE 235
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-5763
Practice Address - Country:US
Practice Address - Phone:512-788-5634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX391211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical