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General NPI Number Information
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NPI Number | 1730429556
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Entity Type | Individual
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Provider Name | LISA MARIE BYRD M.A., LPC
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Gender | Female
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Dates
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Enumeration Date | 02/15/2013
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Last Update Date | 02/15/2013
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Provider Practice Location Address
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Address Line | 3089 DULUTH HIGHWAY 120
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City | DULUTH
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State | GA
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Zip | 30096-3603
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Country | US
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Telephone | 678-523-1650
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Fax |
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Provider Business Mailing Address
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Address Line | 5401 SKYLAR CREEK LN
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City | BUFORD
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State | GA
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Zip | 30518-4403
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Country | US
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Telephone | 678-523-1650
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC004773
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License Number State | GA
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