Provider Demographics
NPI:1467600304
Name:WOLD, LISA DEANNE (LPCC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:DEANNE
Last Name:WOLD
Suffix:
Gender:
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2657 RICE CREEK RD APT 302
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-5378
Mailing Address - Country:US
Mailing Address - Phone:208-249-4238
Mailing Address - Fax:
Practice Address - Street 1:2657 RICE CREEK RD APT 302
Practice Address - Street 2:
Practice Address - City:NEW BRIGHTON
Practice Address - State:MN
Practice Address - Zip Code:55112-5378
Practice Address - Country:US
Practice Address - Phone:208-249-4238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-04
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC001528101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional