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NPI Code Detail

MEDICARE: AMANDA L LIS MS, LMFT

MEDICARE: AMANDA L LIS MS, LMFT
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
1106H00000XMarriage & Family Therapist1139NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1477602779
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA L LIS MS, LMFT
Provider Business Mailing Address
First Line : 8041 STONEHAM CT
Second Line :
City : MATTHEWS
State : NC
Zip : 28105-6435
Country : US
Telephone Number : 704-421-4887
Fax Number :
Provider Business Practice Location Address
First Line : 360 N CASWELL RD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28204-2442
Country : US
Telephone Number : 704-421-4887
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/09/2007
Last Update Date : 11/27/2012

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