Provider Demographics
NPI:1386242345
Name:PLINE, LISA ELAINE (LMSW, CAADC, ADS)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ELAINE
Last Name:PLINE
Suffix:
Gender:F
Credentials:LMSW, CAADC, ADS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2303 KALAMAZOO AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49507-3780
Mailing Address - Country:US
Mailing Address - Phone:616-965-8390
Mailing Address - Fax:
Practice Address - Street 1:2303 KALAMAZOO AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49507-3780
Practice Address - Country:US
Practice Address - Phone:616-965-8390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011189041041C0700X
MI6801104294104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker