Provider Demographics
NPI:1629362926
Name:MERCADEL, LISA DANIELLE
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:DANIELLE
Last Name:MERCADEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2414 HOOVER AVE
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-8581
Mailing Address - Country:US
Mailing Address - Phone:619-336-1226
Mailing Address - Fax:619-477-1052
Practice Address - Street 1:2414 HOOVER AVE STE C
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-8584
Practice Address - Country:US
Practice Address - Phone:619-336-1226
Practice Address - Fax:619-477-1052
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-03
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)