Provider Demographics
NPI:1962025668
Name:LISA B STORY, LLC
Entity Type:Organization
Organization Name:LISA B STORY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:B
Authorized Official - Last Name:STORY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:678-237-1827
Mailing Address - Street 1:3777 SWEAT CREEK RUN
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-1182
Mailing Address - Country:US
Mailing Address - Phone:678-237-1827
Mailing Address - Fax:
Practice Address - Street 1:4343 SHALLOWFORD RD STE E1
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-5056
Practice Address - Country:US
Practice Address - Phone:678-237-1827
Practice Address - Fax:888-975-1953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-28
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
12193610OtherCAQH