Provider Demographics
NPI:1962656504
Name:DUMAIN, LISA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:DUMAIN
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 1:2520 PICKARD MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NC
Mailing Address - Zip Code:27278-7570
Mailing Address - Country:US
Mailing Address - Phone:919-818-6622
Mailing Address - Fax:
Practice Address - Street 1:212 W MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:CARRBORO
Practice Address - State:NC
Practice Address - Zip Code:27510-2082
Practice Address - Country:US
Practice Address - Phone:919-818-6622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-10
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0033661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6007176Medicaid