Provider Demographics
NPI:1134202484
Name:PAUL, LISA MARIE (LCSW)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:MARIE
Last Name:PAUL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 COUNTY ROAD 123
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:AR
Mailing Address - Zip Code:72661-9079
Mailing Address - Country:US
Mailing Address - Phone:318-541-0736
Mailing Address - Fax:
Practice Address - Street 1:1009 COUNTY ROAD 123
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:AR
Practice Address - Zip Code:72661-9079
Practice Address - Country:US
Practice Address - Phone:318-541-0736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2018-08-15
Deactivation Date:2018-05-30
Deactivation Code:
Reactivation Date:2018-08-15
Provider Licenses
StateLicense IDTaxonomies
AR7983-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical