Doctor Name: | LISA M STITES |
NPI Number: | 1003915406 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCPC |
License Number: | 180005216 |
Business Practice Address: | 18w100 22nd St Suite 130 Oakbrook Terrace, IL - 601814499 |
Business Phone Number: | 6304249204 |
Business Fax Number: | |
Mailing Address: | Po Box 387, ADDISON |
State: | IL |
Postal Code: | 601010387 |
Phone Number: | 6304249204 |
Fax Number: | |
NPI Enumeration Date: | 09/22/2006 |
NPI Last Update Date: | 06/11/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 180005216 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |