Provider Demographics
NPI:1174655732
Name:WACHTER, LISA VALERIE (LCAS, LCMHC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:VALERIE
Last Name:WACHTER
Suffix:
Gender:F
Credentials:LCAS, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8505 COTTONTAIL CT
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-4859
Mailing Address - Country:US
Mailing Address - Phone:919-413-5701
Mailing Address - Fax:877-276-4991
Practice Address - Street 1:4024 BARRETT DR STE 201
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609
Practice Address - Country:US
Practice Address - Phone:919-413-5701
Practice Address - Fax:919-808-4326
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
NC3581101YA0400X
NC6503101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC147NKOtherBCBS
NC6103562Medicaid