Provider Demographics
NPI:1518730456
Name:STURDIVANT, LISA (LPCC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:STURDIVANT
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 BENNETT CIR
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-2842
Mailing Address - Country:US
Mailing Address - Phone:606-594-7479
Mailing Address - Fax:606-658-9775
Practice Address - Street 1:60 BENNETT CIR
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-2842
Practice Address - Country:US
Practice Address - Phone:606-594-7479
Practice Address - Fax:606-658-9775
Is Sole Proprietor?:No
Enumeration Date:2023-11-02
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY287830101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional