Provider Demographics
NPI:1285161703
Name:HANSFORD, LISA MICHELLE
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MICHELLE
Last Name:HANSFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 DUSTYS RD
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24426-6020
Mailing Address - Country:US
Mailing Address - Phone:540-968-1179
Mailing Address - Fax:
Practice Address - Street 1:204 DUSTYS RD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:VA
Practice Address - Zip Code:24426-6020
Practice Address - Country:US
Practice Address - Phone:540-968-1179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician