Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 2126 | OR |
N | 103TC0700X | Clinical Psychologist | 2126 | OR |
N | 103G00000X | Clinical Psychologist | 3178 | NC |
N | 103TC0700X | Clinical Psychologist | 3178 | NC |
Y | 103G00000X | Clinical Psychologist | PSY003714 | GA |
Y | 103TC0700X | Clinical Psychologist | PSY003714 | GA |
NPI | 1013091982 |
---|---|
Provider Name | Dr. Lisa B Story |
First Address | Marietta, GA 30062-5023 |
Second Address | Marietta, GA 30062-5023 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 05/05/2014 |