Provider Information for 1225791825
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LISA ELLEN HENTHORN LPC, NCC
Sex: Female
NPI: 1225791825
Last Updated: 2021-11-05
Certification Date: 2021-11-05
Certification Date: 2021-11-05
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1225791825 | ||||||||
| Enumeration Date | 2021-10-20 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 10003 WEBSTER RD CAMDEN ON GAULEY, WV 26208-7713 United States Phone: 304-226-5725 | Fax: | ||||||||
| Primary Practice Address | 10003 WEBSTER RD CAMDEN ON GAULEY, WV 26208-7713 United States Phone: 304-226-5725 | Fax:304-226-3274 | ||||||||
| Secondary Practice Address(es) | 415 MAIN ST | ||||||||
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