Healthcare Provider Details

I. General information

NPI: 1386968345
Provider Name (Legal Business Name): LISA MARIE SESSIONS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2010
Last Update Date: 01/03/2020
Certification Date: 01/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 SW ARCHER ROAD
GAINESVILLE FL
32608-1197
US

IV. Provider business mailing address

1601 SW ARCHER RD
GAINESVILLE FL
32608-1135
US

V. Phone/Fax

Practice location:
  • Phone: 850-218-7766
  • Fax:
Mailing address:
  • Phone: 850-218-7766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW9179
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: