Provider Demographics
NPI:1952877011
Name:HOWE, LISA CHRISTINE (LCSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:CHRISTINE
Last Name:HOWE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:CHRISTINE
Other - Last Name:QUIDWAI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:624 W 9TH ST STE 103
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-3158
Mailing Address - Country:US
Mailing Address - Phone:310-938-4575
Mailing Address - Fax:
Practice Address - Street 1:624 W 9TH ST STE 103
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-3158
Practice Address - Country:US
Practice Address - Phone:310-938-4575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA638901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty