Individual
LISA C BOURGEAULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BA, CASAC
Contact information
Practice address
10 HARLEM ST, GLENS FALLS, NY 12801-2934
(518) 926-7200
(518) 926-7036
Mailing address
100 PARK ST, GLENS FALLS, NY 12801-4413
(518) 926-3207
(518) 926-3215
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
4976
NY
Other
Enumeration date
04/04/2007
Last updated
07/08/2007
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