Provider Demographics
NPI:1255881082
Name:TIGNOR, LISHA (EDS)
Entity type:Individual
Prefix:
First Name:LISHA
Middle Name:
Last Name:TIGNOR
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-1029
Mailing Address - Country:US
Mailing Address - Phone:304-444-7962
Mailing Address - Fax:
Practice Address - Street 1:36 SUNSET DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1029
Practice Address - Country:US
Practice Address - Phone:304-444-7962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-05
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVA8G139800002103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool