Provider Demographics
NPI:1730429556
Name:BYRD, LISA MARIE (MA, LPC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:BYRD
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5401 SKYLAR CREEK LN
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-4403
Mailing Address - Country:US
Mailing Address - Phone:678-523-1650
Mailing Address - Fax:
Practice Address - Street 1:3089 DULUTH HIGHWAY 120
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-3603
Practice Address - Country:US
Practice Address - Phone:678-523-1650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-15
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004773101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional