Healthcare Provider Details

I. General information

NPI: 1194367706
Provider Name (Legal Business Name): LISA MARIE MACKILLOP PSYD, MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2019
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1891 SANTA BARBARA DR STE 102
LANCASTER PA
17601-4106
US

IV. Provider business mailing address

1891 SANTA BARBARA DR STE 102
LANCASTER PA
17601-4106
US

V. Phone/Fax

Practice location:
  • Phone: 717-936-9758
  • Fax: 717-618-6730
Mailing address:
  • Phone: 717-850-3558
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC011850
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC011850
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: