=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720383607
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LISA FLORES, LCSW, P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2011
-----------------------------------------------------
Last Update Date | 01/24/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3518 DRAWBRIDGE PKWY
-----------------------------------------------------
City | GREENSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27410-8432
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-545-3331
-----------------------------------------------------
Fax | 336-545-5142
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3518 DRAWBRIDGE PKWY
-----------------------------------------------------
City | GREENSBORO
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27410-8432
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-545-3331
-----------------------------------------------------
Fax | 336-545-5142
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER / PROVIDER
-----------------------------------------------------
Name | LISA L SHELOR - FLORES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 336-545-3331
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | C000288
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------