Provider Demographics
NPI:1740814045
Name:VOELLER, LISA MARIE (LAC & ICGC II)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:VOELLER
Suffix:
Gender:F
Credentials:LAC & ICGC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3911 20TH AVE S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-4705
Mailing Address - Country:US
Mailing Address - Phone:701-235-7341
Mailing Address - Fax:701-271-3270
Practice Address - Street 1:1905 2ND ST SE STE 18
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-6566
Practice Address - Country:US
Practice Address - Phone:701-838-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-25
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1313101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)