Healthcare Provider Details

I. General information

NPI: 1003771650
Provider Name (Legal Business Name): LISA M MEOLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 ADMIRAL COCHRANE DR STE 225
ANNAPOLIS MD
21401-7583
US

IV. Provider business mailing address

315 S DURHAM ST
BALTIMORE MD
21231-2519
US

V. Phone/Fax

Practice location:
  • Phone: 443-440-5780
  • Fax: 443-909-8721
Mailing address:
  • Phone: 443-909-8721
  • Fax: 443-909-8721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberSC2865
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: