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Individual
LISA FADORSEN
Active
Individual
LISA FADORSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMHC
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
MH15099
FL
101YP2500X
Professional Counselor
1198
MS
101YP2500X
Professional Counselor
E1200017
OH
101YP2500X
Professional Counselor
PMH1252
FL
Other
Enumeration date
10/02/2015
Last updated
03/16/2018
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