Healthcare Provider Details

I. General information

NPI: 1619559986
Provider Name (Legal Business Name): LISA E SBAHIA LPC, LCADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2021
Last Update Date: 04/26/2021
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 N VAN BRUNT ST STE 22
ENGLEWOOD NJ
07631-2716
US

IV. Provider business mailing address

40 N VAN BRUNT ST STE 22
ENGLEWOOD NJ
07631-2716
US

V. Phone/Fax

Practice location:
  • Phone: 201-875-5699
  • Fax: 201-402-6321
Mailing address:
  • Phone: 201-875-5699
  • Fax: 201-402-6321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37LC00310400
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00673600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: