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General NPI Number Information
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NPI Number | 1598022022
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Entity Type | Organization
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Legal Business Name | LISA M. LUBKEMAN-SMITH
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Dates
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Enumeration Date | 04/22/2012
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Last Update Date | 04/27/2015
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Provider Practice Location Address
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Address Line | 3736 N HIGH ST SUITE 102
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City | COLUMBUS
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State | OH
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Zip | 43214-3523
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Country | US
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Telephone | 614-404-2088
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Fax |
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Provider Business Mailing Address
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Address Line | 3736 N HIGH ST SUITE 102
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City | COLUMBUS
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State | OH
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Zip | 43214-3523
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Country | US
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Telephone | 614-404-2088
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR/THERAPIST
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Name | MS. LISA MARIE LUBKEMAN-SMITH
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Credential | LISW
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Telephone | 614-404-2088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | I4970
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License Number State | OH
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