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General NPI Number Information
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NPI Number | 1366886681
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Entity Type | Individual
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Provider Name | LISIANE ANDRADE CHURCH PH.D., LCSW
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Gender | Female
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Dates
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Enumeration Date | 04/18/2013
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Last Update Date | 04/18/2013
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Provider Practice Location Address
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Address Line | 7601 FANNIN ST
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City | HOUSTON
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State | TX
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Zip | 77054
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Country | US
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Telephone | 713-790-0949
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Fax |
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Provider Business Mailing Address
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Address Line | 110 HA SOCIAL WORK BUILDING UNIVERSITY OF HOUSTON
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City | HOUSTON
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State | TX
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Zip | 77204-4013
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Country | US
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Telephone | 713-743-8075
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 28989
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License Number State | TX
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