Provider Demographics
NPI:1891384111
Name:WEAVER, LISA DAWN (LPC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:DAWN
Last Name:WEAVER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 319
Mailing Address - Street 2:
Mailing Address - City:BIGLER
Mailing Address - State:PA
Mailing Address - Zip Code:16825-0319
Mailing Address - Country:US
Mailing Address - Phone:814-342-5678
Mailing Address - Fax:
Practice Address - Street 1:3208 BENNER PIKE
Practice Address - Street 2:
Practice Address - City:BELLEFONTE
Practice Address - State:PA
Practice Address - Zip Code:16823-8475
Practice Address - Country:US
Practice Address - Phone:814-359-7999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC008041101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health