Provider Demographics
NPI:1104451970
Name:CAROTHERS, LISA ANDREA (LMSW)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ANDREA
Last Name:CAROTHERS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1724 N COOK ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-5314
Mailing Address - Country:US
Mailing Address - Phone:509-998-4348
Mailing Address - Fax:509-534-2062
Practice Address - Street 1:1724 N COOK ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-5314
Practice Address - Country:US
Practice Address - Phone:509-998-4348
Practice Address - Fax:509-534-2062
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-11
Last Update Date:2023-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-43205101YM0800X, 1041C0700X
WALMSW-30939104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty