Provider Demographics
NPI:1861629693
Name:SEAGO, LISA K (LPC, CCADC, CCS, CRC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:K
Last Name:SEAGO
Suffix:
Gender:F
Credentials:LPC, CCADC, CCS, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 E 40TH ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31401-9159
Mailing Address - Country:US
Mailing Address - Phone:912-233-1255
Mailing Address - Fax:
Practice Address - Street 1:107 OGLETHORPE PROFESSIONAL CT
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3623
Practice Address - Country:US
Practice Address - Phone:912-353-7699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-19
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005175101Y00000X
NC3976101Y00000X
GAC0049101YA0400X
GA037101YA0400X
GA00016175101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional