Provider Demographics
NPI:1396197042
Name:RISNER, LISA (TCADC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:RISNER
Suffix:
Gender:F
Credentials:TCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6411 VETERANS MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:SHARPSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40374-8001
Mailing Address - Country:US
Mailing Address - Phone:859-432-6176
Mailing Address - Fax:
Practice Address - Street 1:6411 VETERANS MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:SHARPSBURG
Practice Address - State:KY
Practice Address - Zip Code:40374-8001
Practice Address - Country:US
Practice Address - Phone:859-432-6176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-06
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY222Q00000X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist