Individual
MRS. LISA MICHELE DERALEAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1061 HARMON AVE, FORT STEWART, GA 31314-5641
(800) 652-9211
Mailing address
1061 HARMON AVE, FORT STEWART, GA 31314-5641
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
SW6367
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
763219300
—
FL
Enumeration date
07/19/2006
Last updated
05/23/2016
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