Provider Demographics
NPI:1316372246
Name:LISCUM, STEVEN LYLE (LPCA)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:LYLE
Last Name:LISCUM
Suffix:
Gender:M
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2032 PINE NEEDLE CT
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28056-1661
Mailing Address - Country:US
Mailing Address - Phone:704-913-4849
Mailing Address - Fax:
Practice Address - Street 1:2032 PINE NEEDLE CT
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28056-1661
Practice Address - Country:US
Practice Address - Phone:704-913-4849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA10308101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional