Healthcare Provider Details

I. General information

NPI: 1366810129
Provider Name (Legal Business Name): LISA M. CURTIS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2015
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 PINE TREE ST
FLAGLER BEACH FL
32136-3406
US

IV. Provider business mailing address

115 PINE TREE ST
FLAGLER BEACH FL
32136-3406
US

V. Phone/Fax

Practice location:
  • Phone: 864-517-5613
  • Fax:
Mailing address:
  • Phone: 864-517-5613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6632
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: