Provider Demographics
NPI:1831909373
Name:FUSON, LISA MARIE (MA, LSW)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:FUSON
Suffix:
Gender:F
Credentials:MA, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 17
Mailing Address - Street 2:
Mailing Address - City:CRAB ORCHARD
Mailing Address - State:WV
Mailing Address - Zip Code:25827-0017
Mailing Address - Country:US
Mailing Address - Phone:304-228-5477
Mailing Address - Fax:
Practice Address - Street 1:1129 SAXON ROAD
Practice Address - Street 2:
Practice Address - City:GLEN DANIEL
Practice Address - State:WV
Practice Address - Zip Code:25844
Practice Address - Country:US
Practice Address - Phone:304-228-5477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAP00940142104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker