Healthcare Provider Details

I. General information

NPI: 1356779078
Provider Name (Legal Business Name): LISA NILON REDDING MA LPC BSL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2013
Last Update Date: 08/27/2020
Certification Date: 08/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 W FRONT ST STE 214
MEDIA PA
19063-3149
US

IV. Provider business mailing address

210 W FRONT ST STE 214
MEDIA PA
19063-3149
US

V. Phone/Fax

Practice location:
  • Phone: 610-229-9029
  • Fax:
Mailing address:
  • Phone: 102-299-0296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberBH000394
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC010318
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: