Healthcare Provider Details

I. General information

NPI: 1568381614
Provider Name (Legal Business Name): LISA RENE LACKMANN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 N GREENSBORO ST
CARRBORO NC
27510-1845
US

IV. Provider business mailing address

43 MARGARET PL
CHAPEL HILL NC
27516-8945
US

V. Phone/Fax

Practice location:
  • Phone: 919-966-9803
  • Fax:
Mailing address:
  • Phone: 919-966-9803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC002138
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: