Provider Demographics
NPI:1427205491
Name:MARSH, LISA THERESA (CRC)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:THERESA
Last Name:MARSH
Suffix:
Gender:F
Credentials:CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1703 W COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-7000
Mailing Address - Country:US
Mailing Address - Phone:407-276-7463
Mailing Address - Fax:407-284-1053
Practice Address - Street 1:1703 W COLONIAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-7000
Practice Address - Country:US
Practice Address - Phone:407-276-7463
Practice Address - Fax:407-284-1053
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health