Healthcare Provider Details

I. General information

NPI: 1871708057
Provider Name (Legal Business Name): DONNA KAY THOMPSON-LISIECKI LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 12/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 BOWERY LN BLDG. G BOX 41
FOLKSTON GA
31537-5967
US

IV. Provider business mailing address

710 BOWERY LN BLDG. G BOX 41
FOLKSTON GA
31537-5967
US

V. Phone/Fax

Practice location:
  • Phone: 912-496-2616
  • Fax: 912-496-2671
Mailing address:
  • Phone: 912-617-0008
  • Fax: 912-496-2671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC004677
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: