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General NPI Number Information
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NPI Number | 1508071630
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Entity Type | Individual
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Provider Name | LISA WOHLBRUCK MASK LPC,NCC,RN
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Gender | Female
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Dates
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Enumeration Date | 05/11/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1801 E 5TH ST SUITE 106
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City | CHARLOTTE
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State | NC
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Zip | 28204-2379
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Country | US
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Telephone | 704-377-7454
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Fax |
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Provider Business Mailing Address
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Address Line | 2941 HANSON DR
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City | CHARLOTTE
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State | NC
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Zip | 28207-2617
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Country | US
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Telephone | 704-372-9211
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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 | 1079
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License Number State | NC
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