Individual
LISA MARIE LANDERER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPRSS
Contact information
Practice address
228 N BARRON ST, EATON, OH 45320-1704
(937) 456-7694
Mailing address
228 N BARRON ST, EATON, OH 45320-1704
(937) 456-7694
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
CDCA170872
OH
175T00000X
Peer Specialist
Primary
00600
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00600
OHIO MENTAL HEALTH AND ADDICTION SERVICES
OH
Enumeration date
05/14/2018
Last updated
08/01/2019
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