Individual
LISA FORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
90 VILLA NOVA ST, CUTHBERT, GA 39840-6221
(229) 732-5276
Mailing address
90 VILLA NOVA ST, CUTHBERT, GA 39840-6221
(229) 732-5276
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC007439
GA
Other
Enumeration date
10/29/2013
Last updated
10/29/2013
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