Provider Demographics
NPI:1346461738
Name:THOMMEN, LISA A (LCPC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:THOMMEN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 UNION ST
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:DE
Mailing Address - Zip Code:19968-1643
Mailing Address - Country:US
Mailing Address - Phone:410-294-0764
Mailing Address - Fax:410-339-8439
Practice Address - Street 1:320 UNION ST
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:DE
Practice Address - Zip Code:19968-1643
Practice Address - Country:US
Practice Address - Phone:410-294-0764
Practice Address - Fax:410-339-8439
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2152101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD15003700Medicaid