Provider Demographics
NPI:1891934865
Name:FORD, LISA MICHELLE (LCSW/ LCSW-C/ LICSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MICHELLE
Last Name:FORD
Suffix:
Gender:F
Credentials:LCSW/ LCSW-C/ LICSW
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MICHELLE
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:14504 GREENVIEW DR STE 201
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-4203
Mailing Address - Country:US
Mailing Address - Phone:301-247-8755
Mailing Address - Fax:301-895-0044
Practice Address - Street 1:14504 GREENVIEW DR STE 201
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-4203
Practice Address - Country:US
Practice Address - Phone:412-979-3224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-13
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0233051041C0700X
VA09040140471041C0700X
DCLC200020551041C0700X
MD232421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical