Provider Demographics
NPI:1811538622
Name:PARDOE, LCPC, LISA (LCPC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:PARDOE, LCPC
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:MAKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6905 WESTSHORE DR APT 137
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-3587
Mailing Address - Country:US
Mailing Address - Phone:103-106-3384
Mailing Address - Fax:410-498-4888
Practice Address - Street 1:11276 KITTYS CORNER RD
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:MD
Practice Address - Zip Code:21625-2208
Practice Address - Country:US
Practice Address - Phone:410-310-6338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-02
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC6815101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD594012500Medicaid