Provider Demographics
NPI:1356768279
Name:HUNTER, LISA RENE (LPCA)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:RENE
Last Name:HUNTER
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21210 PINE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-9607
Mailing Address - Country:US
Mailing Address - Phone:704-491-7869
Mailing Address - Fax:
Practice Address - Street 1:21210 PINE RIDGE DR
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-9607
Practice Address - Country:US
Practice Address - Phone:704-491-7869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-28
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA10029101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional