Provider Demographics
NPI:1912495961
Name:EHLERS, LISA MICHELE (LCSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MICHELE
Last Name:EHLERS
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 1:126 ENTERPRISE PATH STE 201
Mailing Address - Street 2:
Mailing Address - City:HIRAM
Mailing Address - State:GA
Mailing Address - Zip Code:30141-2654
Mailing Address - Country:US
Mailing Address - Phone:800-729-5700
Mailing Address - Fax:
Practice Address - Street 1:2470 WINDY HILL RD SE STE 238
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8619
Practice Address - Country:US
Practice Address - Phone:770-847-6258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-25
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0061691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical