Provider Demographics
NPI:1437485836
Name:CLARK, LISA LANDERS (LPC)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:LANDERS
Last Name:CLARK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WATERFORD LN
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31411-1305
Mailing Address - Country:US
Mailing Address - Phone:602-751-6077
Mailing Address - Fax:480-452-1113
Practice Address - Street 1:1 WATERFORD LN
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31411-1305
Practice Address - Country:US
Practice Address - Phone:602-751-6077
Practice Address - Fax:480-452-1113
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-20
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6672101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional