Provider Demographics
NPI:1043451131
Name:MIKHAIL, LISA (LISW-S, LICDC)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:MIKHAIL
Suffix:
Gender:F
Credentials:LISW-S, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3125 PAUL ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-1185
Mailing Address - Country:US
Mailing Address - Phone:915-979-5985
Mailing Address - Fax:
Practice Address - Street 1:DYESS AIR FORCE BASE
Practice Address - Street 2:317 MAINTENANCE SQ
Practice Address - City:DYESS AFB
Practice Address - State:TX
Practice Address - Zip Code:79607
Practice Address - Country:US
Practice Address - Phone:915-979-5985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-18
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker