Provider Demographics
NPI:1568612562
Name:CLINE-CREEL, LISA ANN (MA, LPC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:CLINE-CREEL
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 JEFFERSON RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-9732
Mailing Address - Country:US
Mailing Address - Phone:304-205-5071
Mailing Address - Fax:304-205-5138
Practice Address - Street 1:1207 JEFFERSON RD
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-9732
Practice Address - Country:US
Practice Address - Phone:304-205-5071
Practice Address - Fax:304-205-5138
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1770101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional