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General NPI Number Information
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NPI Number | 1114694908
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Entity Type | Individual
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Provider Name | LISA MARIE ANDROVICH LMFT
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Gender | Female
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Dates
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Enumeration Date | 08/27/2021
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Last Update Date | 08/27/2021
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Provider Practice Location Address
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Address Line | 3430 ROBIN LN # 4
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City | CAMERON PARK
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State | CA
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Zip | 95682-8407
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Country | US
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Telephone | 530-676-2899
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Fax | 530-387-6456
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Provider Business Mailing Address
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Address Line | 971 VIA TREVISO
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City | EL DORADO HILLS
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State | CA
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Zip | 95762-7246
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Country | US
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Telephone | 530-919-3969
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 127472
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License Number State | CA
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