Provider Demographics
NPI:1194058263
Name:HUNT, LISA MARI (LCSW-C)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARI
Last Name:HUNT
Suffix:
Gender:
Credentials:LCSW-C
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MARI
Other - Last Name:DAVIES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1936 RUSSELL AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44509-1627
Mailing Address - Country:US
Mailing Address - Phone:330-314-0602
Mailing Address - Fax:
Practice Address - Street 1:65 DUKE ST
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-6128
Practice Address - Country:US
Practice Address - Phone:443-295-8955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-08
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD161361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0844306Medicaid