Provider Demographics
NPI:1003640640
Name:LISEE, CAITLIN
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:LISEE
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 1:3411 S FENMORE RD
Mailing Address - Street 2:
Mailing Address - City:MERRILL
Mailing Address - State:MI
Mailing Address - Zip Code:48637-9706
Mailing Address - Country:US
Mailing Address - Phone:989-860-3796
Mailing Address - Fax:
Practice Address - Street 1:13000 HARBOR CENTER DR STE 301
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-2847
Practice Address - Country:US
Practice Address - Phone:703-492-2994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health