Healthcare Provider Details

I. General information

NPI: 1346028008
Provider Name (Legal Business Name): LISA MICHELLE SROK LCPC, ATR-P, MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2023
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 CLIPPER MILL RD
BALTIMORE MD
21211-1948
US

IV. Provider business mailing address

3600 CLIPPER MILL RD STE 221
BALTIMORE MD
21211-1946
US

V. Phone/Fax

Practice location:
  • Phone: 423-326-5524
  • Fax:
Mailing address:
  • Phone: 443-320-2313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC18403
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number23-316
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: