Individual
LISA MICHELLE FIRESTINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMHC
Contact information
Practice address
6157 STONEY CREEK DR, FORT WAYNE, IN 46825-4409
(260) 570-4515
Mailing address
3715 INDIANA AVE, FORT WAYNE, IN 46807-2213
(260) 849-2041
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
39002689A
IN
Other
Enumeration date
10/24/2024
Last updated
10/24/2024
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