Provider Demographics
NPI:1720383607
Name:LISA FLORES, LCSW, P.A.
Entity Type:Organization
Organization Name:LISA FLORES, LCSW, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SHELOR - FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-545-3331
Mailing Address - Street 1:3518 DRAWBRIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-8432
Mailing Address - Country:US
Mailing Address - Phone:336-545-3331
Mailing Address - Fax:336-545-5142
Practice Address - Street 1:3518 DRAWBRIDGE PKWY
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-8432
Practice Address - Country:US
Practice Address - Phone:336-545-3331
Practice Address - Fax:336-545-5142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-24
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0002881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
137103000OtherMAGELLAN
4671115OtherAETNA
087365OtherVALUE OPTIONS
NC7565KOtherBCBS