Provider Demographics
NPI:1871036178
Name:OLIVER, LISA MARIE (LCPC-C)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:OLIVER
Suffix:
Gender:F
Credentials:LCPC-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 PARK ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5093
Mailing Address - Country:US
Mailing Address - Phone:207-992-0410
Mailing Address - Fax:
Practice Address - Street 1:157 PARK ST
Practice Address - Street 2:SUITE 5
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5093
Practice Address - Country:US
Practice Address - Phone:207-992-0410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-18
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL4765101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health