Healthcare Provider Details

I. General information

NPI: 1710123252
Provider Name (Legal Business Name): LISA ANN BARBER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA ANN CONNELL

II. Dates (important events)

Enumeration Date: 01/06/2009
Last Update Date: 03/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 SOUTH BLVD W # 200
ROCHESTER HILLS MI
48307-5184
US

IV. Provider business mailing address

920 EMILY DRIVE
DAVISON MI
48423
US

V. Phone/Fax

Practice location:
  • Phone: 248-844-6234
  • Fax: 248-844-6237
Mailing address:
  • Phone: 248-420-7922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401011023
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: