Provider Demographics
NPI:1659261386
Name:FAITHFUL, LISA (LMHCA)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:FAITHFUL
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:MS
Other - First Name:LESIA
Other - Middle Name:VALERIIVNA
Other - Last Name:ISHCHENKO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6407 S 12TH ST APT 1709
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98465-1983
Mailing Address - Country:US
Mailing Address - Phone:253-232-7736
Mailing Address - Fax:
Practice Address - Street 1:2910 S MERIDIAN STE 201
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-1585
Practice Address - Country:US
Practice Address - Phone:125-331-7731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-04
Last Update Date:2025-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61537864101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health