Provider Demographics
NPI:1811148463
Name:DORLAND, LISA RENEE (LPCC-S, LSW)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:RENEE
Last Name:DORLAND
Suffix:
Gender:F
Credentials:LPCC-S, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 CLEVELAND AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44702-1805
Mailing Address - Country:US
Mailing Address - Phone:330-455-0374
Mailing Address - Fax:330-453-6716
Practice Address - Street 1:130 1ST ST NW
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44647
Practice Address - Country:US
Practice Address - Phone:330-833-0234
Practice Address - Fax:330-837-7705
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.0018185104100000X, 104100000X
OHE.0002909101YP2500X
OHE2909101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0242555Medicaid