Provider Demographics
NPI:1497046486
Name:POORE, LISA G (MS, LPC)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:G
Last Name:POORE
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3905 JOHNS CREEK CT
Mailing Address - Street 2:SUITE 260
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-1224
Mailing Address - Country:US
Mailing Address - Phone:770-753-0350
Mailing Address - Fax:770-497-9536
Practice Address - Street 1:3905 JOHNS CREEK CT
Practice Address - Street 2:SUITE 260
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-1224
Practice Address - Country:US
Practice Address - Phone:770-753-0350
Practice Address - Fax:770-497-9536
Is Sole Proprietor?:No
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC001741101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional