Provider Demographics
NPI:1558695338
Name:LISAMARIE EUSTICE, LLC
Entity Type:Organization
Organization Name:LISAMARIE EUSTICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN/BUSINESS CO-OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISAMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:EUSTICE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:301-802-5697
Mailing Address - Street 1:4829 WEST LN
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-5317
Mailing Address - Country:US
Mailing Address - Phone:301-802-5697
Mailing Address - Fax:
Practice Address - Street 1:4829 WEST LN
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-5317
Practice Address - Country:US
Practice Address - Phone:301-802-5697
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-25
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD138431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty