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General NPI Number Information
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NPI Number | 1669610333
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Entity Type | Individual
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Provider Name | LISA J. FICKER PHD
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Gender | Female
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Dates
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Enumeration Date | 02/03/2009
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Last Update Date | 02/26/2020
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Provider Practice Location Address
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Address Line | 8303 SIX FORKS RD STE 207
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City | RALEIGH
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State | NC
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Zip | 27615-3094
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Country | US
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Telephone | 248-613-9669
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Fax |
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Provider Business Mailing Address
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Address Line | 22561 DOVER HILL CT
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City | FARMINGTON HILLS
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State | MI
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Zip | 48335-3912
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Country | US
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Telephone | 248-613-9669
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301015019
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License Number State | MI
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