Provider Demographics
NPI:1376431791
Name:CONYERS, LISA MARIE (LPC, CRC)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:MARIE
Last Name:CONYERS
Suffix:
Gender:F
Credentials:LPC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3060 ENTERPRISE DRIVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-3306
Mailing Address - Country:US
Mailing Address - Phone:814-880-1047
Mailing Address - Fax:
Practice Address - Street 1:3060 ENTERPRISE DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801
Practice Address - Country:US
Practice Address - Phone:814-880-1047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-25
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC001074101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health