Provider Demographics
NPI:1851602585
Name:SEATON, LISA JOHNSON (LCSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:JOHNSON
Last Name:SEATON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3104 GLENNHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:BYRAM
Mailing Address - State:MS
Mailing Address - Zip Code:39272-9377
Mailing Address - Country:US
Mailing Address - Phone:601-953-0105
Mailing Address - Fax:
Practice Address - Street 1:3104 GLENNHAVEN DR
Practice Address - Street 2:
Practice Address - City:BYRAM
Practice Address - State:MS
Practice Address - Zip Code:39272-9377
Practice Address - Country:US
Practice Address - Phone:601-953-0105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-28
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC47071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical