Provider Demographics
NPI:1952034027
Name:KOLOFSKY, LISA (LCPC-C)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:KOLOFSKY
Suffix:
Gender:F
Credentials:LCPC-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 HOGFAT HILL RD
Mailing Address - Street 2:
Mailing Address - City:SEBAGO
Mailing Address - State:ME
Mailing Address - Zip Code:04029-3053
Mailing Address - Country:US
Mailing Address - Phone:207-291-5677
Mailing Address - Fax:
Practice Address - Street 1:125 HOGFAT HILL RD
Practice Address - Street 2:
Practice Address - City:SEBAGO
Practice Address - State:ME
Practice Address - Zip Code:04029-3053
Practice Address - Country:US
Practice Address - Phone:207-291-5677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-06
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL6546101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health