Provider Demographics
NPI:1245363266
Name:DANIEL, LISA ALLISON (MSSW)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ALLISON
Last Name:DANIEL
Suffix:
Gender:F
Credentials:MSSW
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:A
Other - Last Name:DANIEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:1820 MEMORIAL DR STE 101
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-4693
Mailing Address - Country:US
Mailing Address - Phone:931-553-4161
Mailing Address - Fax:
Practice Address - Street 1:1820 MEMORIAL DR STE 101
Practice Address - Street 2:SUITE 3
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-4693
Practice Address - Country:US
Practice Address - Phone:931-553-4161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000036771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3923874Medicare ID - Type Unspecified