Provider Demographics
NPI:1588753347
Name:ANDERSON, LISA SMART (LCSW)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:SMART
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:973 BLACKEYED SUSAN PL
Mailing Address - Street 2:
Mailing Address - City:VASS
Mailing Address - State:NC
Mailing Address - Zip Code:28394-8412
Mailing Address - Country:US
Mailing Address - Phone:910-245-3260
Mailing Address - Fax:
Practice Address - Street 1:160 PINEHURST AVE
Practice Address - Street 2:J
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-6352
Practice Address - Country:US
Practice Address - Phone:910-693-7777
Practice Address - Fax:910-693-1524
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC003019104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002370Medicaid