Provider Demographics
NPI:1427071935
Name:GODWIN, LISA ROBIN (MA, LPC)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ROBIN
Last Name:GODWIN
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:ROBIN
Other - Last Name:JOHNSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:5115 TIMICUAN WAY
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-9059
Mailing Address - Country:US
Mailing Address - Phone:843-367-8973
Mailing Address - Fax:843-285-8838
Practice Address - Street 1:5115 TIMICUAN WAY
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-9059
Practice Address - Country:US
Practice Address - Phone:843-367-8973
Practice Address - Fax:843-285-8838
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4647101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional