| Doctor Name: | LISA FADORSEN |
| NPI Number: | 1275903288 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | PMH1252 |
| Business Practice Address: | 302 W Main St Saint Clairsville, OH - 439508801 |
| Business Phone Number: | 7409687006 |
| Business Fax Number: | |
| Mailing Address: | 302 W Main St, SAINT CLAIRSVILLE |
| State: | OH |
| Postal Code: | 439508801 |
| Phone Number: | 7409687006 |
| Fax Number: | |
| NPI Enumeration Date: | 10/02/2015 |
| NPI Last Update Date: | 10/02/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | PMH1252 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | FL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |