Individual
LISHA FANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCDC
Contact information
Practice address
3941 HOLCOMB BRIDGE RD STE 100, PEACHTREE CORNERS, GA 30092-2292
(855) 850-0274
Mailing address
4125 HUNTLEIGH DR, SAN ANGELO, TX 76904-1405
(325) 716-6333
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
11296
TX
Other
Enumeration date
03/23/2021
Last updated
09/22/2023
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