Provider Demographics
NPI:1265593297
Name:BALL COLEMAN, LISA MARIE (LCSWC)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MARIE
Last Name:BALL COLEMAN
Suffix:
Gender:F
Credentials:LCSWC
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:COLEMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6122 SUICIDE BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:E NEW MARKET
Mailing Address - State:MD
Mailing Address - Zip Code:21631
Mailing Address - Country:US
Mailing Address - Phone:410-479-3800
Mailing Address - Fax:
Practice Address - Street 1:606 SUNNYSIDE AVE
Practice Address - Street 2:CAROLINE CO MENTAL HEALTH CLINIC
Practice Address - City:DENTON
Practice Address - State:MD
Practice Address - Zip Code:21629
Practice Address - Country:US
Practice Address - Phone:410-479-3800
Practice Address - Fax:410-479-0052
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06137104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker