Provider Demographics
NPI:1871708057
Name:THOMPSON-LISIECKI, DONNA KAY (LPC)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:KAY
Last Name:THOMPSON-LISIECKI
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 BOWERY LN
Mailing Address - Street 2:BLDG. G BOX 41
Mailing Address - City:FOLKSTON
Mailing Address - State:GA
Mailing Address - Zip Code:31537-5967
Mailing Address - Country:US
Mailing Address - Phone:912-617-0008
Mailing Address - Fax:912-496-2671
Practice Address - Street 1:710 BOWERY LN
Practice Address - Street 2:BLDG. G BOX 41
Practice Address - City:FOLKSTON
Practice Address - State:GA
Practice Address - Zip Code:31537-5967
Practice Address - Country:US
Practice Address - Phone:912-496-2616
Practice Address - Fax:912-496-2671
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004677101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA20-8008619OtherFEDERAL EMPLOYER ID #