Provider Demographics
NPI:1578909073
Name:LISA C PAUL, LICSW LLC
Entity Type:Organization
Organization Name:LISA C PAUL, LICSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:PAUL
Authorized Official - Suffix:
Authorized Official - Credentials:MSW; LICSW
Authorized Official - Phone:304-319-0466
Mailing Address - Street 1:5 PALMETTO DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-8003
Mailing Address - Country:US
Mailing Address - Phone:304-319-0466
Mailing Address - Fax:
Practice Address - Street 1:5000 GREENBAG RD STE E7
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26501-7123
Practice Address - Country:US
Practice Address - Phone:304-319-0466
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-12
Last Update Date:2013-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDP00942479261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health