Provider Demographics
NPI:1457932782
Name:GLASS, LISA (MA, MED, NCC)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:GLASS
Suffix:
Gender:F
Credentials:MA, MED, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 ARMOUR DR NE STE E
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-3975
Mailing Address - Country:US
Mailing Address - Phone:404-617-1850
Mailing Address - Fax:
Practice Address - Street 1:199 ARMOUR DR NE STE E
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-3975
Practice Address - Country:US
Practice Address - Phone:404-617-1850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health