Basic Information
| Provider Information | |||||||||
| NPI: | 1609115542 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHANKMAN-PRICE | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LMFT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SHANKMAN | ||||||||
| OtherFirstName: | LISA | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | LMFT | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1000 JEFFERSON ST. | ||||||||
| Address2: | STE. 2C | ||||||||
| City: | LYNCHBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 24504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6173790496 | ||||||||
| FaxNumber: | 6178070958 | ||||||||
| Practice Location | |||||||||
| Address1: | 8800 ROSWELL RD. | ||||||||
| Address2: | STE. A135 | ||||||||
| City: | SANDY SPRINGS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4046821923 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2013 | ||||||||
| LastUpdateDate: | 03/24/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | MFT001204 | GA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | 001204 | GA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.