Healthcare Provider Details

I. General information

NPI: 1619035847
Provider Name (Legal Business Name): LISA KATE LAC, LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 12/29/2022
Certification Date: 12/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 COTTAGE ST
BRATTLEBORO VT
05301-6560
US

IV. Provider business mailing address

11 COTTAGE ST
BRATTLEBORO VT
05301-6560
US

V. Phone/Fax

Practice location:
  • Phone: 717-706-4826
  • Fax:
Mailing address:
  • Phone: 717-706-4826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberUO2575
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number091.0134085
License Number StateVT
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number068.0000493
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: