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NPI Code Detail

MEDICARE: MS. LISA M DALTON MA LPC

MEDICARE:  MS. LISA M DALTON  MA LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor5390NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1659430353
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LISA M DALTON MA LPC
Provider Business Mailing Address
First Line : PO BOX 601
Second Line :
City : STONEVILLE
State : NC
Zip : 27048-0601
Country : US
Telephone Number : 336-627-1514
Fax Number :
Provider Business Practice Location Address
First Line : 1606 WELLINGTON AVE UNIT C
Second Line :
City : WILMINGTON
State : NC
Zip : 28401-7704
Country : US
Telephone Number : 910-799-4505
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/08/2006
Last Update Date : 10/18/2012

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