Provider Demographics
NPI:1366886681
Name:CHURCH, LISIANE ANDRADE (PHD, LCSW)
Entity type:Individual
Prefix:MRS
First Name:LISIANE
Middle Name:ANDRADE
Last Name:CHURCH
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 HA SOCIAL WORK BUILDING
Mailing Address - Street 2:UNIVERSITY OF HOUSTON
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77204-4013
Mailing Address - Country:US
Mailing Address - Phone:713-743-8075
Mailing Address - Fax:
Practice Address - Street 1:7601 FANNIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054
Practice Address - Country:US
Practice Address - Phone:713-790-0949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-18
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX289891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical