| Doctor Name: | LISA MARY CHARLEBOIS |
| NPI Number: | 1851310957 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | L.C.S.W. |
| License Number: | LCS 15125 |
| Business Practice Address: | 11344 Coloma Rd Suite 250 Gold River, CA - 956704457 |
| Business Phone Number: | 9165526122 |
| Business Fax Number: | 9168525838 |
| Mailing Address: | 11344 Coloma Rd, Suite 250 GOLD RIVER |
| State: | CA |
| Postal Code: | 956704457 |
| Phone Number: | 9165526122 |
| Fax Number: | 9168525838 |
| NPI Enumeration Date: | 07/19/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | LCS 15125 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |