Provider Demographics
NPI:1447797725
Name:CANADY, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:CANADY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6527 COLERAIN AVE
Mailing Address - Street 2:APT 317
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45239-5537
Mailing Address - Country:US
Mailing Address - Phone:513-970-8678
Mailing Address - Fax:
Practice Address - Street 1:6527 COLERAIN AVE
Practice Address - Street 2:APT 317
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45239-5537
Practice Address - Country:US
Practice Address - Phone:513-834-7063
Practice Address - Fax:513-245-0531
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.162606101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)