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General NPI Number Information
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NPI Number | 1588976971
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Entity Type | Individual
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Provider Name | LISA M DEVORE PH.D.
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Gender | Female
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Dates
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Enumeration Date | 07/14/2010
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Last Update Date | 01/23/2024
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Provider Practice Location Address
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Address Line | 15720 BRIXHAM HILL AVE STE 300
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City | CHARLOTTE
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State | NC
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Zip | 28277-4784
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Country | US
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Telephone | 704-412-8360
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Fax | 704-603-3006
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Provider Business Mailing Address
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Address Line | 15720 BRIXHAM HILL AVE STE 300
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City | CHARLOTTE
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State | NC
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Zip | 28277-4784
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Country | US
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Telephone | 704-412-8360
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Fax | 704-603-3006
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 1829
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 4386
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License Number State | NC
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