Provider Demographics
NPI:1467864199
Name:ADLER-BACON, LISA N (MS,LPCC-S, LSW)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:N
Last Name:ADLER-BACON
Suffix:
Gender:F
Credentials:MS,LPCC-S, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 HADLEY AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45419-2609
Mailing Address - Country:US
Mailing Address - Phone:937-609-3948
Mailing Address - Fax:937-298-9004
Practice Address - Street 1:255 HADLEY AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45419-2609
Practice Address - Country:US
Practice Address - Phone:937-609-3948
Practice Address - Fax:937-298-9004
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-29
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0007838101YP2500X
OH0025289104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker