Provider Demographics
NPI:1376161760
Name:STRUBE, LISA J (LPC, CRC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:J
Last Name:STRUBE
Suffix:
Gender:F
Credentials:LPC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 LENOX POINTE NE STE C
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-7426
Mailing Address - Country:US
Mailing Address - Phone:404-549-5152
Mailing Address - Fax:
Practice Address - Street 1:49 LENOX POINTE NE STE C
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-7426
Practice Address - Country:US
Practice Address - Phone:404-549-5152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-11
Last Update Date:2020-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC010992101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional