Provider Demographics
NPI:1679806681
Name:GOJANOVIC, LISA (PCC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:GOJANOVIC
Suffix:
Gender:F
Credentials:PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 BAKER BLVD
Mailing Address - Street 2:
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-3601
Mailing Address - Country:US
Mailing Address - Phone:330-864-6331
Mailing Address - Fax:330-572-0639
Practice Address - Street 1:63 BAKER BLVD
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3601
Practice Address - Country:US
Practice Address - Phone:330-572-0641
Practice Address - Fax:330-572-0643
Is Sole Proprietor?:No
Enumeration Date:2009-09-09
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0004081101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional