Provider Demographics
NPI:1780084947
Name:CHRISTESON, LISA (LPC, NCC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:CHRISTESON
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:KOERKENMEIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, NCC
Mailing Address - Street 1:103 N GORDON LN
Mailing Address - Street 2:APT. A
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-1985
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1257 E WALNUT ST
Practice Address - Street 2:#1
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-5002
Practice Address - Country:US
Practice Address - Phone:618-351-9700
Practice Address - Fax:618-351-9701
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-25
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178008926101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor