Provider Demographics
NPI:1750198560
Name:ACHILLE, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:ACHILLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5546 YEAGER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-4867
Mailing Address - Country:US
Mailing Address - Phone:215-500-1863
Mailing Address - Fax:
Practice Address - Street 1:5546 YEAGER RIDGE DR
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-4867
Practice Address - Country:US
Practice Address - Phone:215-500-1863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician