Provider Demographics
NPI:1255614764
Name:HEISTERKAMP DAVIS, LISA DIANE (LMHC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:DIANE
Last Name:HEISTERKAMP DAVIS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 ACADEMY STREET
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476-6436
Mailing Address - Country:US
Mailing Address - Phone:617-529-3829
Mailing Address - Fax:
Practice Address - Street 1:54 ACADEMY STREET
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476-6436
Practice Address - Country:US
Practice Address - Phone:617-529-3829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health