Provider Demographics
NPI:1386899409
Name:MODAK, LILLIAN (LPC)
Entity type:Individual
Prefix:
First Name:LILLIAN
Middle Name:
Last Name:MODAK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 E UNION ST
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-3449
Mailing Address - Country:US
Mailing Address - Phone:828-433-9190
Mailing Address - Fax:828-433-9130
Practice Address - Street 1:205 E UNION ST
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-3449
Practice Address - Country:US
Practice Address - Phone:828-433-9190
Practice Address - Fax:828-433-9130
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional