Provider Demographics
NPI:1134648504
Name:LONDON, LISA MARIE (LCPC, NCC, DBH)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:MARIE
Last Name:LONDON
Suffix:
Gender:F
Credentials:LCPC, NCC, DBH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 W RANDOLPH ST UNIT 2107
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-1438
Mailing Address - Country:US
Mailing Address - Phone:312-848-1534
Mailing Address - Fax:
Practice Address - Street 1:1400 W RANDOLPH ST UNIT 2107
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-1438
Practice Address - Country:US
Practice Address - Phone:312-848-1534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-16
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.012779101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health