Provider Demographics
NPI:1457124315
Name:WOOLSTON, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:WOOLSTON
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 1:7617 CITA LN UNIT 101
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34653-6216
Mailing Address - Country:US
Mailing Address - Phone:727-755-9300
Mailing Address - Fax:833-905-0111
Practice Address - Street 1:7617 CITA LN UNIT 101
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-6216
Practice Address - Country:US
Practice Address - Phone:727-755-9300
Practice Address - Fax:833-905-0111
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-02
Last Update Date:2024-11-01
Deactivation Date:2024-10-18
Deactivation Code:
Reactivation Date:2024-11-01
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical