Provider Demographics
NPI:1467130872
Name:FLORENZANO, LISA (LCMHC-A)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:FLORENZANO
Suffix:
Gender:F
Credentials:LCMHC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 OAK VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-4480
Mailing Address - Country:US
Mailing Address - Phone:704-466-5583
Mailing Address - Fax:
Practice Address - Street 1:101 HEALING FARM LN
Practice Address - Street 2:
Practice Address - City:MILL SPRING
Practice Address - State:NC
Practice Address - Zip Code:28756-5808
Practice Address - Country:US
Practice Address - Phone:828-899-4673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-06
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA11669101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health