Provider Demographics
NPI:1275768756
Name:RALEY, LISA L (LCSW, PIP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:L
Last Name:RALEY
Suffix:
Gender:F
Credentials:LCSW, PIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 YELLOW CREEK DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:AL
Mailing Address - Zip Code:35572-7038
Mailing Address - Country:US
Mailing Address - Phone:256-668-9383
Mailing Address - Fax:
Practice Address - Street 1:24420 HIGHWAY 278
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:AL
Practice Address - Zip Code:35572-2701
Practice Address - Country:US
Practice Address - Phone:256-668-9383
Practice Address - Fax:256-668-9383
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-27
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2189C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical