Provider Demographics
NPI:1336339886
Name:COWAN, LISA FAYE (MSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:FAYE
Last Name:COWAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:748 LORD DUNMORE DR
Mailing Address - Street 2:SUITE 107
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-2664
Mailing Address - Country:US
Mailing Address - Phone:619-892-1379
Mailing Address - Fax:757-486-3429
Practice Address - Street 1:748 LORD DUNMORE DR
Practice Address - Street 2:SUITE 107
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-2664
Practice Address - Country:US
Practice Address - Phone:619-892-1379
Practice Address - Fax:757-486-3429
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904004802104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker