MEDICARE: LISA WILLIS LCPC, LCADC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	LCA402	MD
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	LCA402	MD
3	101YP2500X	Professional Counselor	LC12800	MD

General Provider Information

NPI Number	:	1447558234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA WILLIS LCPC, LCADC

Provider Business Mailing Address
First Line	:	8101 SANDY SPRING RD STE 300
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20707-3596
Country	:	US
Telephone Number	:	240-459-8517
Fax Number	:

Provider Business Practice Location Address
First Line	:	8101 SANDY SPRING RD STE 300
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20707-3596
Country	:	US
Telephone Number	:	240-459-8517
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2011
Last Update Date	:	05/01/2024

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