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NPI Code Detail

MEDICARE: LORRAINE NICOLE DURISSEAU MA, LPC-MHSP

MEDICARE: LORRAINE NICOLE DURISSEAU MA, LPC-MHSP
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
1101YM0800XMental Health Counselor2693TN
2101YP2500XProfessional Counselor2693TN

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 : 1801195995
Entity Type Code : Individual
Provider Name (Legal Business Name) : LORRAINE NICOLE DURISSEAU MA, LPC-MHSP
Provider Business Mailing Address
First Line : 1635 CHESTNUT ST
Second Line :
City : CHATTANOOGA
State : TN
Zip : 37408-1024
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1635 CHESTNUT ST
Second Line :
City : CHATTANOOGA
State : TN
Zip : 37408-1024
Country : US
Telephone Number : 877-258-8795
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/15/2011
Last Update Date : 05/06/2016

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Directions to “ LORRAINE NICOLE DURISSEAU MA, LPC-MHSP” Practice Location

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