MEDICARE: LISA THOMAS MS, LPC, ATR-BC

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	101YP2500X	Professional Counselor	0701011111	VA

General Provider Information

NPI Number	:	1578224614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA THOMAS MS, LPC, ATR-BC

Provider Business Mailing Address
First Line	:	900 GRANBY ST STE 206
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23510-2567
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 GRANBY ST STE 206
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23510-2567
Country	:	US
Telephone Number	:	757-756-5254
Fax Number	:

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

Provider Enumeration Date	:	12/30/2021
Last Update Date	:	10/06/2023

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