Provider Demographics
NPI:1104903129
Name:PERRY, LISA THIEKE (MED, LCMHC, NCC,)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:THIEKE
Last Name:PERRY
Suffix:
Gender:F
Credentials:MED, LCMHC, NCC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 PARAMOUNT DR
Mailing Address - Street 2:
Mailing Address - City:LEICESTER
Mailing Address - State:NC
Mailing Address - Zip Code:28748-6308
Mailing Address - Country:US
Mailing Address - Phone:828-575-3073
Mailing Address - Fax:
Practice Address - Street 1:79 WOODFIN PL STE 205A
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-8400
Practice Address - Country:US
Practice Address - Phone:828-575-3073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2022-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10533101YP2500X
NJ37PC00026200101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional