Provider Demographics
NPI:1144787698
Name:INFANTE, LISETTE (LPC)
Entity Type:Individual
Prefix:
First Name:LISETTE
Middle Name:
Last Name:INFANTE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3840 FAIRHILL PT
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-5027
Mailing Address - Country:US
Mailing Address - Phone:770-375-7798
Mailing Address - Fax:
Practice Address - Street 1:881 PONCE DE LEON AVE NE STE 7
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30306-4259
Practice Address - Country:US
Practice Address - Phone:770-298-3088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-20
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC009980101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GALPC009980OtherPROFESSIONAL LICENSE