Provider Demographics
NPI:1962577478
Name:LINDBLOM, LISA IOANNIDIS (LPC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:IOANNIDIS
Last Name:LINDBLOM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:IOANNIDIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:5712 SPOTSWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:OH
Mailing Address - Zip Code:44124-4088
Mailing Address - Country:US
Mailing Address - Phone:440-935-4232
Mailing Address - Fax:
Practice Address - Street 1:12557 RAVENWOOD DR
Practice Address - Street 2:
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-9009
Practice Address - Country:US
Practice Address - Phone:440-285-3568
Practice Address - Fax:440-285-4552
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC0500049101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional