Provider Demographics
NPI:1669011334
Name:LAMPHIERE, LISA (CADC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:LAMPHIERE
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:985 E BARNEY AVE
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-1708
Mailing Address - Country:US
Mailing Address - Phone:231-220-0008
Mailing Address - Fax:
Practice Address - Street 1:985 E BARNEY AVE
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-1708
Practice Address - Country:US
Practice Address - Phone:231-220-0008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-30
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2-01454101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2-01454OtherMICHIGAN CERTIFICATION BOARD FOR ADDICTION PROFESSIONALS