Healthcare Provider Details

I. General information

NPI: 1033457221
Provider Name (Legal Business Name): LISA MICHELE MBRIWA M.A., LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2013
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5314 EASTLAND CT SE
ROME GA
30161-8849
US

IV. Provider business mailing address

5314 EASTLAND CT SE
ROME GA
30161-8849
US

V. Phone/Fax

Practice location:
  • Phone: 610-984-5862
  • Fax:
Mailing address:
  • Phone: 610-984-5862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC010360
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: