Provider Demographics
NPI:1134256043
Name:PRESTON, LISA MACKEY (LISW-CP)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:MACKEY
Last Name:PRESTON
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:MACKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:2310 FURMAN DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-7021
Mailing Address - Country:US
Mailing Address - Phone:800-868-1032
Mailing Address - Fax:
Practice Address - Street 1:4101 PERCIVAL RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-8320
Practice Address - Country:US
Practice Address - Phone:800-868-1032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC67451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical