Provider Demographics
NPI:1902123490
Name:TOLUFASHE, LISA YVONNE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:YVONNE
Last Name:TOLUFASHE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 324
Mailing Address - Street 2:
Mailing Address - City:PAW CREEK
Mailing Address - State:NC
Mailing Address - Zip Code:28130-0324
Mailing Address - Country:US
Mailing Address - Phone:704-392-1522
Mailing Address - Fax:
Practice Address - Street 1:1028 JORDANS POND LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28214-7148
Practice Address - Country:US
Practice Address - Phone:704-392-1522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-23
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0078241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical