Provider Demographics
NPI:1538878103
Name:RHOADS, LISA L
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:L
Last Name:RHOADS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:761 MIAMISBURG CENTERVILLE RD # OH45459
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-6501
Mailing Address - Country:US
Mailing Address - Phone:513-999-8085
Mailing Address - Fax:
Practice Address - Street 1:761 MIAMISBURG CENTERVILLE RD # OH45459
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-6501
Practice Address - Country:US
Practice Address - Phone:513-999-8085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-22
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1902119101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health