Provider Demographics
NPI:1811459944
Name:FRASER-POWELL, LISA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:FRASER-POWELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2503 LOCH VIEW CT SW
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-6856
Mailing Address - Country:US
Mailing Address - Phone:678-549-4436
Mailing Address - Fax:
Practice Address - Street 1:2503 LOCH VIEW CT SW
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-6856
Practice Address - Country:US
Practice Address - Phone:678-549-4436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-06
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0064931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical