Provider Demographics
NPI:1699007765
Name:BALDWIN, LISA K (LPC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:K
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 RUCKER BLVD
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:AL
Mailing Address - Zip Code:36330-2236
Mailing Address - Country:US
Mailing Address - Phone:334-417-0212
Mailing Address - Fax:334-417-0213
Practice Address - Street 1:1405 RUCKER BLVD
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-2236
Practice Address - Country:US
Practice Address - Phone:334-417-0212
Practice Address - Fax:334-417-0213
Is Sole Proprietor?:No
Enumeration Date:2010-02-01
Last Update Date:2024-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
AL04998101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001428100Medicaid