Provider Demographics
NPI:1396214854
Name:WHIGHAM, LISA M (MS)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:M
Last Name:WHIGHAM
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:WHIGHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4026 MARINA ISLE DR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-1830
Mailing Address - Country:US
Mailing Address - Phone:347-920-0707
Mailing Address - Fax:
Practice Address - Street 1:3483 W VINE ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4668
Practice Address - Country:US
Practice Address - Phone:407-928-0444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-14
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health