Healthcare Provider Details

I. General information

NPI: 1235582412
Provider Name (Legal Business Name): LISA MARIE FOSTER LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LISA MARIE LUBLIN LPCC

II. Dates (important events)

Enumeration Date: 07/22/2016
Last Update Date: 07/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1446 REYNOLDS RD SUITE #313
MAUMEE OH
43537-1684
US

IV. Provider business mailing address

427 W DUSSEL DR #205
MAUMEE OH
43537-4208
US

V. Phone/Fax

Practice location:
  • Phone: 419-720-5800
  • Fax: 419-720-4444
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.1300244
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: