Provider Demographics
NPI:1649510231
Name:LISA, JOANNE (MA, NCC, LPCA)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:LISA
Suffix:
Gender:F
Credentials:MA, NCC, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6017 HOPE LN
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-9417
Mailing Address - Country:US
Mailing Address - Phone:609-933-1404
Mailing Address - Fax:
Practice Address - Street 1:800 W WILLIAMS ST STE 280
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-5203
Practice Address - Country:US
Practice Address - Phone:919-504-5126
Practice Address - Fax:919-289-1735
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-19
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA8602101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health