Healthcare Provider Details

I. General information

NPI: 1649700212
Provider Name (Legal Business Name): LISA MICHELLE STEPHANS LAPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12586 NORTH MAIN STREET
TRENTON GA
30752
US

IV. Provider business mailing address

501 MIZE ST
LA FAYETTE GA
30728-3346
US

V. Phone/Fax

Practice location:
  • Phone: 706-956-5526
  • Fax: 706-639-2054
Mailing address:
  • Phone: 706-638-5580
  • Fax: 706-639-2054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPC005882
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: