Provider Demographics
NPI:1346791050
Name:LABIANCA, LISA (LLP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:LABIANCA
Suffix:
Gender:F
Credentials:LLP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:GOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLP
Mailing Address - Street 1:23262 COBB WOODS LN
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20148-7490
Mailing Address - Country:US
Mailing Address - Phone:269-757-2002
Mailing Address - Fax:
Practice Address - Street 1:4905 DEL RAY AVE STE 301
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-2558
Practice Address - Country:US
Practice Address - Phone:240-752-7650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012254103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist