Provider Demographics
NPI:1508593369
Name:WEEAMS, LISA MCKINNEY (LPC, CRC, LPN, CCM)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:MCKINNEY
Last Name:WEEAMS
Suffix:
Gender:F
Credentials:LPC, CRC, LPN, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7495 HIGHWAY 195
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38068-6229
Mailing Address - Country:US
Mailing Address - Phone:901-459-1949
Mailing Address - Fax:
Practice Address - Street 1:7495 HIGHWAY 195
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38068-6229
Practice Address - Country:US
Practice Address - Phone:901-459-1949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-02
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN040409164W00000X
TX335398164X00000X
NJ4230652171M00000X
IL183488225C00000X
IL178.021286101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No164X00000XNursing Service ProvidersLicensed Vocational Nurse
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor