Provider Demographics
NPI:1194024778
Name:SMALLWOOD, LISA MARIA (LPC,CAC II, NCAC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIA
Last Name:SMALLWOOD
Suffix:
Gender:F
Credentials:LPC,CAC II, NCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5422 PINEFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29154-1020
Mailing Address - Country:US
Mailing Address - Phone:803-316-0402
Mailing Address - Fax:
Practice Address - Street 1:5422 PINEFIELD RD
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29154-1020
Practice Address - Country:US
Practice Address - Phone:803-316-0402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5061101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)