Provider Demographics
NPI:1609273838
Name:FREDSALL, LISA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:FREDSALL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 SWISS PINE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:SPRUCE PINE
Mailing Address - State:NC
Mailing Address - Zip Code:28777-3333
Mailing Address - Country:US
Mailing Address - Phone:828-385-0939
Mailing Address - Fax:
Practice Address - Street 1:119 TUNNEL RD STE D
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28805-1800
Practice Address - Country:US
Practice Address - Phone:828-989-9284
Practice Address - Fax:828-689-3997
Is Sole Proprietor?:No
Enumeration Date:2014-12-03
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0091511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1851574503Medicaid
NC1144375767Medicaid
NC1851574503Medicare NSC
NC1851574503Medicare UPIN
NC1144375767Medicaid
NC1851574503Medicaid
NC1144375767Medicare NSC
NC1144375767Medicare PIN