Healthcare Provider Details

I. General information

NPI: 1609937077
Provider Name (Legal Business Name): LISA E ALLEN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 GREAT BRIDGE BLVD CHESAPEAKE COMM SERV BOARD
CHESAPEAKE VA
23320
US

IV. Provider business mailing address

PO BOX 1647 224 GREAT BRIDGE BLVD CHESAPEAKE COMMUNITY SERVICES BOA
CHESAPEAKE VA
23320
US

V. Phone/Fax

Practice location:
  • Phone: 757-547-9334
  • Fax: 757-819-6292
Mailing address:
  • Phone: 757-547-9334
  • Fax: 757-819-6292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701003582LPC
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: