Healthcare Provider Details

I. General information

NPI: 1093901928
Provider Name (Legal Business Name): LISA BALDWIN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA BALDWIN MHPP

II. Dates (important events)

Enumeration Date: 09/25/2007
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1809 EXECUTIVE SQ
JONESBORO AR
72401-6086
US

IV. Provider business mailing address

3432 HUDSON CT
JONESBORO AR
72405-8865
US

V. Phone/Fax

Practice location:
  • Phone: 501-273-4044
  • Fax:
Mailing address:
  • Phone: 501-273-4044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP1808106
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: