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General NPI Number Information
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NPI Number | 1548067259
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Entity Type | Individual
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Provider Name | LISA SUSAN HALLOCK LCPC
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Gender | Female
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Dates
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Enumeration Date | 02/28/2025
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Last Update Date | 02/28/2025
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Provider Practice Location Address
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Address Line | 2124 BAY FRONT TER
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City | ANNAPOLIS
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State | MD
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Zip | 21409-5705
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Country | US
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Telephone | 773-966-9270
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Fax |
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Provider Business Mailing Address
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Address Line | 2124 BAY FRONT TER
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City | ANNAPOLIS
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State | MD
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Zip | 21409-5705
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Country | US
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Telephone | 773-966-9270
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 180002220
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LC15565
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License Number State | MD
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