Provider Demographics
NPI:1326187568
Name:BRITT, LISA MARIE (LCAS, CRC)
Entity Type:Individual
Prefix:MISS
First Name:LISA
Middle Name:MARIE
Last Name:BRITT
Suffix:
Gender:F
Credentials:LCAS, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1033 AVENT HL
Mailing Address - Street 2:APT B9
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-8001
Mailing Address - Country:US
Mailing Address - Phone:919-538-1665
Mailing Address - Fax:919-989-1791
Practice Address - Street 1:1302 W MARKET ST
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-3339
Practice Address - Country:US
Practice Address - Phone:919-989-1786
Practice Address - Fax:919-989-1791
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1122101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6005614Medicaid
NC8700356Medicaid
NC5901780Medicaid
NC8301075Medicaid