Provider Demographics
NPI:1861022683
Name:LISA R LEACE LISW-S COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:LISA R LEACE LISW-S COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEACE
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-S
Authorized Official - Phone:513-283-9132
Mailing Address - Street 1:270 NORTHLAND BLVD STE 211
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:OH
Mailing Address - Zip Code:45246-3653
Mailing Address - Country:US
Mailing Address - Phone:513-283-7132
Mailing Address - Fax:
Practice Address - Street 1:270 NORTHLAND BLVD STE 211
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-3653
Practice Address - Country:US
Practice Address - Phone:513-283-7132
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-21
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health