Provider Demographics
NPI:1255156311
Name:DEHART, LISA GAIL (MS, EDS)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:GAIL
Last Name:DEHART
Suffix:
Gender:F
Credentials:MS, EDS
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:DEHART
Other - Last Name:AUSTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, EDS
Mailing Address - Street 1:1508 WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-4613
Mailing Address - Country:US
Mailing Address - Phone:540-239-2490
Mailing Address - Fax:
Practice Address - Street 1:300 PONTIAC AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21225-2042
Practice Address - Country:US
Practice Address - Phone:443-836-6400
Practice Address - Fax:301-253-9417
Is Sole Proprietor?:No
Enumeration Date:2024-11-22
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool