Provider Demographics
NPI:1285137885
Name:JOYCE, LISA (CSC-AD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:JOYCE
Suffix:
Gender:F
Credentials:CSC-AD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:953 W PULASKI HWY STE B
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-4714
Mailing Address - Country:US
Mailing Address - Phone:443-485-6544
Mailing Address - Fax:
Practice Address - Street 1:953 W PULASKI HWY STE B
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-4714
Practice Address - Country:US
Practice Address - Phone:443-485-6544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-10
Last Update Date:2018-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDSC2193101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)