Provider Demographics
NPI:1962631663
Name:JOHANNS, LISA MARIE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MARIE
Last Name:JOHANNS
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 1:153 HAZARD AVE
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-4592
Mailing Address - Country:US
Mailing Address - Phone:860-250-5020
Mailing Address - Fax:860-250-5030
Practice Address - Street 1:153 HAZARD AVE
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-4592
Practice Address - Country:US
Practice Address - Phone:860-250-5020
Practice Address - Fax:860-250-5030
Is Sole Proprietor?:No
Enumeration Date:2009-07-02
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002077101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional