Provider Demographics
NPI:1558512954
Name:RICH, LISA ANNETTE (MA LPC)
Entity Type:Individual
Prefix:MISS
First Name:LISA
Middle Name:ANNETTE
Last Name:RICH
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:MISS
Other - First Name:LISA
Other - Middle Name:ANNETTE
Other - Last Name:RICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA LPC
Mailing Address - Street 1:228 ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-1135
Mailing Address - Country:US
Mailing Address - Phone:304-633-9938
Mailing Address - Fax:
Practice Address - Street 1:3062 WILSON RD
Practice Address - Street 2:
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504-9674
Practice Address - Country:US
Practice Address - Phone:304-633-9938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV 1758101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health