Provider Demographics
NPI:1790001584
Name:DONNELLAN, LISA ANNE (LPCA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANNE
Last Name:DONNELLAN
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 PROFESSIONAL PARK DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-5599
Mailing Address - Country:US
Mailing Address - Phone:704-661-1009
Mailing Address - Fax:704-664-1029
Practice Address - Street 1:134 PROFESSIONAL PARK DR
Practice Address - Street 2:SUITE 400
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-5599
Practice Address - Country:US
Practice Address - Phone:704-661-1009
Practice Address - Fax:704-664-1029
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7776A101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional