Provider Demographics
NPI:1669610333
Name:FICKER, LISA J (PHD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:J
Last Name:FICKER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22561 DOVER HILL CT
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-3912
Mailing Address - Country:US
Mailing Address - Phone:248-613-9669
Mailing Address - Fax:
Practice Address - Street 1:8303 SIX FORKS RD STE 207
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-3094
Practice Address - Country:US
Practice Address - Phone:248-613-9669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-03
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301015019103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical