Provider Demographics
NPI:1881751238
Name:RANKIN, LISA M (LCPC, NCC, CTS)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:RANKIN
Suffix:
Gender:F
Credentials:LCPC, NCC, CTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 W LINCOLN AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:IL
Mailing Address - Zip Code:61920-2456
Mailing Address - Country:US
Mailing Address - Phone:217-508-7953
Mailing Address - Fax:
Practice Address - Street 1:506 W LINCOLN AVE STE 500
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:IL
Practice Address - Zip Code:61920-2456
Practice Address - Country:US
Practice Address - Phone:217-508-7953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-005907101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional