Provider Demographics
NPI:1497819155
Name:LIPSCOMB, DELISHA LATRAE
Entity Type:Individual
Prefix:
First Name:DELISHA
Middle Name:LATRAE
Last Name:LIPSCOMB
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 1:175 GWINNETT DR
Mailing Address - Street 2:SUITE 213
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-8444
Mailing Address - Country:US
Mailing Address - Phone:678-377-3745
Mailing Address - Fax:678-990-3997
Practice Address - Street 1:175 GWINNETT DR
Practice Address - Street 2:SUITE 213
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-8444
Practice Address - Country:US
Practice Address - Phone:678-377-3745
Practice Address - Fax:678-990-3997
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor