Provider Demographics
NPI:1831333509
Name:DOUTHERD, LISA (LLPC, BSW)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:DOUTHERD
Suffix:
Gender:F
Credentials:LLPC, BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5031 PARK LAKE RD
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-3835
Mailing Address - Country:US
Mailing Address - Phone:517-332-0811
Mailing Address - Fax:517-332-4452
Practice Address - Street 1:306 W WILLOW ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48906-4740
Practice Address - Country:US
Practice Address - Phone:517-702-3500
Practice Address - Fax:517-484-5169
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-27
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802074536104100000X
MI6401012198101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker