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General NPI Number Information
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NPI Number | 1174080394
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Entity Type | Individual
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Provider Name | LISA CAMERON LPC
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Gender | Female
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Dates
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Enumeration Date | 02/24/2019
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | 1200 W GODFREY AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19141-3323
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Country | US
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Telephone | 215-444-7469
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 746722
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City | ATLANTA
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State | GA
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Zip | 30374-6722
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Country | US
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Telephone | 469-727-6675
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PC005206
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License Number State | PA
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