Provider Demographics
NPI:1275073850
Name:WARE, LISA (ADULT PEER SUPPORT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:WARE
Suffix:
Gender:F
Credentials:ADULT PEER SUPPORT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1588 HILL RISE DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-2587
Mailing Address - Country:US
Mailing Address - Phone:859-255-0890
Mailing Address - Fax:859-255-0854
Practice Address - Street 1:1588 HILL RISE DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-2587
Practice Address - Country:US
Practice Address - Phone:859-255-0890
Practice Address - Fax:859-255-0854
Is Sole Proprietor?:No
Enumeration Date:2017-03-02
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist