Provider Demographics
NPI:1134572688
Name:DE LA O, LIZA (MA, NCC, LPC)
Entity type:Individual
Prefix:
First Name:LIZA
Middle Name:
Last Name:DE LA O
Suffix:
Gender:F
Credentials:MA, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 FLORAL AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-3431
Mailing Address - Country:US
Mailing Address - Phone:223-386-0731
Mailing Address - Fax:
Practice Address - Street 1:375 FLORAL AVE STE 102
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-3431
Practice Address - Country:US
Practice Address - Phone:223-386-0731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-20
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC011268101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health