Healthcare Provider Details

I. General information

NPI: 1104106756
Provider Name (Legal Business Name): LISA EMILIE GROARK MA, NCC, LPCMH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2011
Last Update Date: 08/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 CHAPMAN RD
NEWARK DE
19702-5490
US

IV. Provider business mailing address

260 CHAPMAN RD
NEWARK DE
19702-5490
US

V. Phone/Fax

Practice location:
  • Phone: 302-292-1334
  • Fax:
Mailing address:
  • Phone: 302-292-1334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC-0000563
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: