Provider Demographics
NPI:1871502963
Name:BOADO, LISA GAY
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:GAY
Last Name:BOADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 FIELDCREST RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-2343
Mailing Address - Country:US
Mailing Address - Phone:910-690-1385
Mailing Address - Fax:
Practice Address - Street 1:185 E NEW HAMPSHIRE AVE
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-5529
Practice Address - Country:US
Practice Address - Phone:910-690-1385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health