Provider Demographics
NPI:1154532760
Name:HASKINS, LISA ELLEN (LCPC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ELLEN
Last Name:HASKINS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-0011
Mailing Address - Country:US
Mailing Address - Phone:207-837-8691
Mailing Address - Fax:207-833-2445
Practice Address - Street 1:98 MAINE ST
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-2031
Practice Address - Country:US
Practice Address - Phone:207-837-8691
Practice Address - Fax:207-833-2445
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC1295101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health