Provider Demographics
NPI:1740706878
Name:SERFASS, LISA ANN (LCPC)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ANN
Last Name:SERFASS
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:VILLA MARIA OF MOUNTAIN MARYLAND
Mailing Address - Street 2:300 E. OLDTOWN ROAD
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502
Mailing Address - Country:US
Mailing Address - Phone:301-777-8685
Mailing Address - Fax:
Practice Address - Street 1:300 E OLDTOWN RD
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-3600
Practice Address - Country:US
Practice Address - Phone:301-777-8685
Practice Address - Fax:301-777-8687
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-21
Last Update Date:2017-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2163101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health