Provider Demographics
NPI:1356817308
Name:DRISCOLL, LISA LYNN (SUDP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:LYNN
Last Name:DRISCOLL
Suffix:
Gender:F
Credentials:SUDP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:LYNN
Other - Last Name:HUSSEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4301 HOYT AVE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203-2316
Mailing Address - Country:US
Mailing Address - Phone:509-209-8674
Mailing Address - Fax:
Practice Address - Street 1:4301 HOYT AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-2316
Practice Address - Country:US
Practice Address - Phone:509-209-8674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-17
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60235888101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)