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NPI Code Detail

MEDICARE: MRS. LISA MICHELLE IVEY MSW, LCSWA

MEDICARE: MRS. LISA MICHELLE IVEY MSW, LCSWA
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
1101Y00000XCounselor

General Provider Information

NPI Number : 1821556564
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LISA MICHELLE IVEY MSW, LCSWA
Provider Business Mailing Address
First Line : 2505 N MCMILLAN AVE
Second Line :
City : LUMBERTON
State : NC
Zip : 28358-3547
Country : US
Telephone Number : 910-733-7858
Fax Number : 910-737-4083
Provider Business Practice Location Address
First Line : 900 N CHESTNUT ST
Second Line :
City : LUMBERTON
State : NC
Zip : 28358-4854
Country : US
Telephone Number : 910-733-7858
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/12/2019
Last Update Date : 03/12/2019

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