Provider Demographics
NPI:1508088717
Name:HANSFORD, LISA (MA LSW)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:HANSFORD
Suffix:
Gender:F
Credentials:MA LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10019 FREDERICK PIKE
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:OH
Mailing Address - Zip Code:45377-9721
Mailing Address - Country:US
Mailing Address - Phone:937-361-3196
Mailing Address - Fax:
Practice Address - Street 1:133 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-4620
Practice Address - Country:US
Practice Address - Phone:937-433-3931
Practice Address - Fax:937-434-7678
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS 0600848104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHS0600848OtherCSWMFT BOARD