Provider Demographics
NPI:1790330595
Name:LAMBUTH, LISA-MARIE (MS, LCMHC)
Entity Type:Individual
Prefix:
First Name:LISA-MARIE
Middle Name:
Last Name:LAMBUTH
Suffix:
Gender:F
Credentials:MS, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 LAKE HURST DR
Mailing Address - Street 2:
Mailing Address - City:DUDLEY
Mailing Address - State:NC
Mailing Address - Zip Code:28333-9324
Mailing Address - Country:US
Mailing Address - Phone:919-584-0041
Mailing Address - Fax:
Practice Address - Street 1:515 N GEORGE ST UNIT 17
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-2724
Practice Address - Country:US
Practice Address - Phone:919-584-0041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-08
Last Update Date:2023-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15058101YP2500X
NCA15058101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional