Healthcare Provider Details

I. General information

NPI: 1952811887
Provider Name (Legal Business Name): LISA NEUHAUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2017
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1209 CULBRETH DR STE 100
WILMINGTON NC
28405-8318
US

IV. Provider business mailing address

1209 CULBRETH DR STE 100
WILMINGTON NC
28405-8318
US

V. Phone/Fax

Practice location:
  • Phone: 910-800-2730
  • Fax: 910-800-2731
Mailing address:
  • Phone: 910-800-2730
  • Fax: 910-800-2731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number20794A
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: