Provider Demographics
NPI:1598891749
Name:STUBBS, LISA VITALE (EDD, LMHC)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:VITALE
Last Name:STUBBS
Suffix:
Gender:F
Credentials:EDD, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2886 SE CALVIN ST
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-5808
Mailing Address - Country:US
Mailing Address - Phone:772-398-2317
Mailing Address - Fax:
Practice Address - Street 1:2886 SE CALVIN ST
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-5808
Practice Address - Country:US
Practice Address - Phone:772-398-2317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH6999101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health