Provider Demographics
NPI:1265527691
Name:FLANNIGAN, LISA A (PHD)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:A
Last Name:FLANNIGAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 SUN VALLEY DR STE A4
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-1480
Mailing Address - Country:US
Mailing Address - Phone:678-948-8202
Mailing Address - Fax:
Practice Address - Street 1:500 SUN VALLEY DR STE A4
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-1480
Practice Address - Country:US
Practice Address - Phone:678-948-8202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2020-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002661103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist