Provider Demographics
NPI:1801677216
Name:GUNTER, LISA ROCHELLE (MA)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ROCHELLE
Last Name:GUNTER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8406 SIX FORKS RD STE 204
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-3074
Mailing Address - Country:US
Mailing Address - Phone:919-769-5134
Mailing Address - Fax:
Practice Address - Street 1:8406 SIX FORKS RD STE 204
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-3074
Practice Address - Country:US
Practice Address - Phone:919-617-9656
Practice Address - Fax:919-561-6883
Is Sole Proprietor?:No
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA19195101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health