Provider Demographics
NPI:1508037094
Name:WEABER, LISA M (LPC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:WEABER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:208 E PLUME ST
Mailing Address - Street 2:SUITE 247
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-1757
Mailing Address - Country:US
Mailing Address - Phone:757-289-5885
Mailing Address - Fax:757-622-2011
Practice Address - Street 1:7460 CENTRAL BUSINESS PARK DRIVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23513
Practice Address - Country:US
Practice Address - Phone:757-289-5885
Practice Address - Fax:757-622-2011
Is Sole Proprietor?:No
Enumeration Date:2008-03-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004195101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional