Provider Demographics
NPI:1346464831
Name:MONATH, LISA (BS, CADCII)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:MONATH
Suffix:
Gender:F
Credentials:BS, CADCII
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:KOHLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:154 ETOWAH RD
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:TN
Mailing Address - Zip Code:37307-3109
Mailing Address - Country:US
Mailing Address - Phone:706-463-9767
Mailing Address - Fax:
Practice Address - Street 1:1289 GI MADDOX PKWY
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:GA
Practice Address - Zip Code:30705-2069
Practice Address - Country:US
Practice Address - Phone:706-971-3366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1195101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)