Provider Demographics
NPI:1427208362
Name:LISA B CREEF LCSW, PC
Entity Type:Organization
Organization Name:LISA B CREEF LCSW, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:B
Authorized Official - Last Name:CREEF
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:252-335-5346
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:SOUTH MILLS
Mailing Address - State:NC
Mailing Address - Zip Code:27976-0188
Mailing Address - Country:US
Mailing Address - Phone:252-335-5346
Mailing Address - Fax:252-335-5365
Practice Address - Street 1:1241 B NORTH ROAD ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-3335
Practice Address - Country:US
Practice Address - Phone:252-335-5346
Practice Address - Fax:252-335-5365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-29
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0061381041C0700X
VA09040014971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA332387OtherBC/BS
NC6007190Medicaid
VA8909725Medicaid
VA332387OtherBC/BS