Provider Demographics
NPI:1447654249
Name:WITKOWSKI, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:WITKOWSKI
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 1:5454 NEWCASTLE DRIVE
Mailing Address - Street 2:APT. 1842
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5454 NEWCASTLE DRIVE
Practice Address - Street 2:APT. 1842
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081
Practice Address - Country:US
Practice Address - Phone:908-268-1590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-22
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70091101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional