Provider Demographics
NPI:1336694017
Name:FOLLMER, LISA A (LCSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:FOLLMER
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 1:4000 W METROPOLITAN DR STE 401
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3506
Mailing Address - Country:US
Mailing Address - Phone:714-935-6117
Mailing Address - Fax:714-935-6066
Practice Address - Street 1:4000 W METROPOLITAN DR STE 401
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3504
Practice Address - Country:US
Practice Address - Phone:714-935-6117
Practice Address - Fax:714-935-6066
Is Sole Proprietor?:No
Enumeration Date:2016-08-23
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA922241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical