Provider Demographics
NPI:1841349180
Name:KOPACKA-JONES, LISA ANN (LMSW)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:ANN
Last Name:KOPACKA-JONES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 LIVERNOIS RD STE 500
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1219
Mailing Address - Country:US
Mailing Address - Phone:248-680-8203
Mailing Address - Fax:
Practice Address - Street 1:27351 DEQUINDRE RD
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071
Practice Address - Country:US
Practice Address - Phone:248-967-7292
Practice Address - Fax:248-967-7876
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010631781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical