Provider Demographics
NPI:1801393202
Name:FACTOR, LISA (LPCA)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:FACTOR
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 RIVER KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:NC
Mailing Address - Zip Code:28640-9392
Mailing Address - Country:US
Mailing Address - Phone:336-902-3599
Mailing Address - Fax:
Practice Address - Street 1:19 E ASHE ST STE D
Practice Address - Street 2:
Practice Address - City:WEST JEFFERSON
Practice Address - State:NC
Practice Address - Zip Code:28694-6022
Practice Address - Country:US
Practice Address - Phone:336-902-3888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-11
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA12130101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional