Provider Demographics
NPI:1275673337
Name:SMITH, LISA ANN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 UPCHURCH DR
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-5575
Mailing Address - Country:US
Mailing Address - Phone:901-603-1444
Mailing Address - Fax:
Practice Address - Street 1:1055 UPCHURCH DR
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-5575
Practice Address - Country:US
Practice Address - Phone:901-603-1444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR11651-C1041C0700X
TNLCSW000051581041C0700X
TNCSW00000069361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical