Provider Demographics
NPI:1174742837
Name:GIOVANNELLI, LISA MARIE (PHD, PCC-S, LICDC)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:MARIE
Last Name:GIOVANNELLI
Suffix:
Gender:F
Credentials:PHD, PCC-S, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3926 CLOCK POINTE TRL
Mailing Address - Street 2:SUITE 103
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-6965
Mailing Address - Country:US
Mailing Address - Phone:330-529-2002
Mailing Address - Fax:330-529-2002
Practice Address - Street 1:3926 CLOCK POINTE TRL
Practice Address - Street 2:SUITE 103
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-6965
Practice Address - Country:US
Practice Address - Phone:330-529-2002
Practice Address - Fax:330-529-2002
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
OH0800007101YP2500X
OH011296101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)