Provider Demographics
NPI:1417958448
Name:JUDD, LISA L (MSW LISW-CP ACSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:L
Last Name:JUDD
Suffix:
Gender:F
Credentials:MSW LISW-CP ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 PARKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29302-4019
Mailing Address - Country:US
Mailing Address - Phone:864-504-0708
Mailing Address - Fax:
Practice Address - Street 1:504 PARKVIEW DR
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-4019
Practice Address - Country:US
Practice Address - Phone:864-504-0708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-01
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6639104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker