Healthcare Provider Details

I. General information

NPI: 1730849977
Provider Name (Legal Business Name): LISA MICHELLE SUNSHINE CANADA LCADC, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2021
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 CAL HILL SPUR
PINE KNOT KY
42635-9194
US

IV. Provider business mailing address

PO BOX 302
PINE KNOT KY
42635-0302
US

V. Phone/Fax

Practice location:
  • Phone: 606-376-9355
  • Fax:
Mailing address:
  • Phone: 606-310-1107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number288968
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number168351
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: