Provider Demographics
NPI:1669517058
Name:WITT, LINDA LIZAK (MA, LPCC)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:LIZAK
Last Name:WITT
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:MS
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:LIZAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:409 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-1770
Mailing Address - Country:US
Mailing Address - Phone:513-409-5050
Mailing Address - Fax:513-409-5031
Practice Address - Street 1:409 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036
Practice Address - Country:US
Practice Address - Phone:513-409-5050
Practice Address - Fax:513-409-5031
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1700447101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHE.1700447OtherCOUNSELOR, SOCIAL WORKER AND MARRIAGE AND FAMILY THERAPIST BOARD