Individual
ALEXUS NICOLE LISATH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCDCIII
Contact information
Practice address
303 OFFNERE ST, PORTSMOUTH, OH 45662-4655
(407) 150-0947
Mailing address
303 OFFNERE ST, PORTSMOUTH, OH 45662-4655
(740) 715-0094
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
162667
OH
Other
Enumeration date
01/29/2021
Last updated
07/28/2025
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