Provider Demographics
NPI:1346513009
Name:THRIFT-BLATNICA, LISA (BCCC)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:THRIFT-BLATNICA
Suffix:
Gender:F
Credentials:BCCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92118-1309
Mailing Address - Country:US
Mailing Address - Phone:619-319-5722
Mailing Address - Fax:
Practice Address - Street 1:9465 FARNHAM ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1308
Practice Address - Country:US
Practice Address - Phone:858-308-4669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-10
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health