Provider Demographics
NPI:1821385717
Name:MONTEITH, LISA JEAN (LPC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:JEAN
Last Name:MONTEITH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 HUDSON ST
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:SC
Mailing Address - Zip Code:29706-1524
Mailing Address - Country:US
Mailing Address - Phone:803-377-8111
Mailing Address - Fax:803-581-5380
Practice Address - Street 1:130 HUDSON ST
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:SC
Practice Address - Zip Code:29706-1524
Practice Address - Country:US
Practice Address - Phone:803-377-8111
Practice Address - Fax:803-581-5380
Is Sole Proprietor?:No
Enumeration Date:2011-06-30
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3466101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional