Provider Demographics
NPI:1962957860
Name:WICH-LAYMAN, LISA ANNE (LPC, LCAS)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANNE
Last Name:WICH-LAYMAN
Suffix:
Gender:F
Credentials:LPC, LCAS
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ANNE
Other - Last Name:LAYMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC, LCAS
Mailing Address - Street 1:6109 NORTHSHORE DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-7234
Mailing Address - Country:US
Mailing Address - Phone:910-431-9455
Mailing Address - Fax:910-401-1769
Practice Address - Street 1:1522 HARBOUR DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7714
Practice Address - Country:US
Practice Address - Phone:910-688-3575
Practice Address - Fax:910-401-1769
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-20
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22897101YA0400X
NC12528101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)