MEDICARE: LISA GAY BOADO

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
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1871502963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA GAY BOADO

Provider Business Mailing Address
First Line	:	255 FIELDCREST RD
Second Line	:
City	:	SOUTHERN PINES
State	:	NC
Zip	:	28387-2343
Country	:	US
Telephone Number	:	910-690-1385
Fax Number	:

Provider Business Practice Location Address
First Line	:	185 E NEW HAMPSHIRE AVE
Second Line	:
City	:	SOUTHERN PINES
State	:	NC
Zip	:	28387-5529
Country	:	US
Telephone Number	:	910-690-1385
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	07/08/2007

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Directions to “ LISA GAY BOADO ” Practice Location

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