Provider Demographics
NPI:1134441389
Name:SAWADOGO, LISA MARIE (MS)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:SAWADOGO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:SAWADOGO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPCC
Mailing Address - Street 1:6114 LA SALLE AVE STE 757
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-2802
Mailing Address - Country:US
Mailing Address - Phone:510-560-3508
Mailing Address - Fax:
Practice Address - Street 1:555 RALPH APPEZZATO MEMORIAL PRKWY
Practice Address - Street 2:
Practice Address - City:ALMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501
Practice Address - Country:US
Practice Address - Phone:510-560-3508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-15
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CA357101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor