Provider Demographics
NPI:1194510891
Name:THOMAS EL, LISA IRENE (LCADC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:IRENE
Last Name:THOMAS EL
Suffix:
Gender:
Credentials:LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1251 N OHIO AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08401-1825
Mailing Address - Country:US
Mailing Address - Phone:252-665-6795
Mailing Address - Fax:
Practice Address - Street 1:2600 TILTON RD UNIT 5147
Practice Address - Street 2:
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-1831
Practice Address - Country:US
Practice Address - Phone:800-484-1890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-12
Last Update Date:2025-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00223900101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)