Provider Demographics
NPI:1295996270
Name:CARY, LISA DUKE (LPC, CEAP, CRC, CRP)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:DUKE
Last Name:CARY
Suffix:
Gender:F
Credentials:LPC, CEAP, CRC, CRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 EBENEZER RD
Mailing Address - Street 2:SUITE 225
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-4103
Mailing Address - Country:US
Mailing Address - Phone:803-329-9639
Mailing Address - Fax:803-329-5830
Practice Address - Street 1:1721 EBENEZER RD
Practice Address - Street 2:SUITE 225
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-4103
Practice Address - Country:US
Practice Address - Phone:803-329-9639
Practice Address - Fax:803-329-5830
Is Sole Proprietor?:No
Enumeration Date:2008-06-22
Last Update Date:2017-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003959101YP2500X
SC6539101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1295996270Medicaid