Provider Demographics
NPI:1285845180
Name:HISAW, GINGER RENAE (MAMFC, LMFT)
Entity type:Individual
Prefix:MISS
First Name:GINGER
Middle Name:RENAE
Last Name:HISAW
Suffix:
Gender:F
Credentials:MAMFC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 SHERWOOD RD
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-3518
Mailing Address - Country:US
Mailing Address - Phone:318-290-8061
Mailing Address - Fax:
Practice Address - Street 1:901 MAIN ST
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-6407
Practice Address - Country:US
Practice Address - Phone:318-290-8061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1042106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist