Provider Demographics
NPI:1730288531
Name:MARTIN, LISA ANN (LPCC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1669 QUAIL MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-8110
Mailing Address - Country:US
Mailing Address - Phone:740-654-9120
Mailing Address - Fax:
Practice Address - Street 1:131 NORTH EWING STREET
Practice Address - Street 2:SUITE B
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130
Practice Address - Country:US
Practice Address - Phone:740-689-6700
Practice Address - Fax:740-689-6702
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0003593101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional