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General NPI Number Information
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NPI Number | 1427282953
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Entity Type | Individual
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Provider Name | LISA RENEE' FORD LADC, LPC, LMHC
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Gender | Female
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Dates
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Enumeration Date | 05/12/2009
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Last Update Date | 12/21/2023
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Provider Practice Location Address
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Address Line | 374 E LITCHFIELD RD
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City | LITCHFIELD
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State | CT
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Zip | 06759-2901
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Country | US
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Telephone | 203-815-8267
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Fax |
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Provider Business Mailing Address
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Address Line | 374 E LITCHFIELD RD
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City | LITCHFIELD
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State | CT
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Zip | 06759-2901
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Country | US
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Telephone | 203-815-8267
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | MATS-4751
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 000845
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 001800
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License Number State | CT
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