Provider Demographics
NPI:1366292831
Name:COLONA, LISA KAY (LCPC)
Entity type:Individual
Prefix:MR
First Name:LISA
Middle Name:KAY
Last Name:COLONA
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6505 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:SYKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21784-6356
Mailing Address - Country:US
Mailing Address - Phone:540-598-6976
Mailing Address - Fax:
Practice Address - Street 1:6210 GEORGETOWN BLVD STE AB&C
Practice Address - Street 2:
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-6418
Practice Address - Country:US
Practice Address - Phone:410-216-5500
Practice Address - Fax:410-567-0401
Is Sole Proprietor?:No
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC10375101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional