Provider Demographics
NPI:1639621279
Name:OJST, LISA (LCPC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:OJST
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:SKURATON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1215 ANNAPOLIS RD STE 204
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-1351
Mailing Address - Country:US
Mailing Address - Phone:410-975-0067
Mailing Address - Fax:
Practice Address - Street 1:1215 ANNAPOLIS RD STE 204
Practice Address - Street 2:
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-1351
Practice Address - Country:US
Practice Address - Phone:410-975-0067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-31
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC6796101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional