Provider Demographics
NPI:1871741231
Name:LISA URANGA MHT AND ASSOCIATED
Entity type:Organization
Organization Name:LISA URANGA MHT AND ASSOCIATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:DRIVER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:919-449-8306
Mailing Address - Street 1:105 KINGFISHER WAY
Mailing Address - Street 2:
Mailing Address - City:LOUISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:27549-7560
Mailing Address - Country:US
Mailing Address - Phone:919-449-8306
Mailing Address - Fax:919-340-0671
Practice Address - Street 1:10520 LIGON MILL RD
Practice Address - Street 2:SUITE 108
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-4575
Practice Address - Country:US
Practice Address - Phone:919-340-0133
Practice Address - Fax:919-340-0671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-28
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103291Medicaid