Provider Demographics
NPI:1669241733
Name:MOCKERIDGE, LIZALIZA (LCPC)
Entity type:Individual
Prefix:MS
First Name:LIZALIZA
Middle Name:
Last Name:MOCKERIDGE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 FOSS FARM RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03824-2923
Mailing Address - Country:US
Mailing Address - Phone:734-417-1604
Mailing Address - Fax:
Practice Address - Street 1:2 FOSS FARM RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NH
Practice Address - Zip Code:03824-2923
Practice Address - Country:US
Practice Address - Phone:734-417-1604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-29
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC7049101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health