Provider Demographics
NPI:1326552589
Name:VESPICO-MULL, LISA MARIE (LPC, CAADC, SAP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MARIE
Last Name:VESPICO-MULL
Suffix:
Gender:F
Credentials:LPC, CAADC, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:293 UNIVERSITY PKWY
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29909-6072
Mailing Address - Country:US
Mailing Address - Phone:610-763-2411
Mailing Address - Fax:843-208-6168
Practice Address - Street 1:293 UNIVERSITY PKWY
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29909-6072
Practice Address - Country:US
Practice Address - Phone:484-577-3760
Practice Address - Fax:843-208-6168
Is Sole Proprietor?:No
Enumeration Date:2017-11-27
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA7624101YA0400X
PAPC008250101YP2500X
SC8502101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)