Provider Demographics
NPI:1548388200
Name:LAM, LISA MARIE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MARIE
Last Name:LAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:SCHUTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9300 DEWITT LOOP
Mailing Address - Street 2:FORT BELVOIR COMMUNITY HOSPITAL - BEHAVIORAL HEALTH
Mailing Address - City:FORT BELVOIR
Mailing Address - State:VA
Mailing Address - Zip Code:22060
Mailing Address - Country:US
Mailing Address - Phone:571-231-1295
Mailing Address - Fax:571-231-1283
Practice Address - Street 1:9300 DEWITT LOOP RIVER PAVILLION, 2ND FLOOR
Practice Address - Street 2:FORT BELVOIR COMMUNITY HOSPITAL -
Practice Address - City:FORT BELVOIR
Practice Address - State:VA
Practice Address - Zip Code:22060
Practice Address - Country:US
Practice Address - Phone:571-231-1295
Practice Address - Fax:571-231-1283
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040080991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1306875695OtherYOUTH VILLAGES