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Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

LISA JOSEPHINE DESTEFANO MA
NPI 1154993004
Counselor - Addiction (Substance Use Disorder) in Myrtle Beach, SC

Active since July 12, 2021
1607 EXECUTIVE AVE, MYRTLE BEACH, SC 29577(843) 712-7316(843) 945-1022 Get Directions Write a Review

NPPES record last updated: October 1, 2026. Verified against the NPPES registry weekly; last sync: October 04, 2026.

Record update history: Oct 1, 2026, Jul 12, 2021 (2 updates tracked since 2021).

About Lisa Josephine Destefano Ma NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LISA JOSEPHINE DESTEFANO MA (NPI 1154993004) is an individual addiction (substance use disorder) provider in Myrtle Beach, South Carolina, licensed in South Carolina (ADC-IP3071) and active in the NPI registry since July 2021. She maintains a secondary practice location in Bennettsville.

NPPES Registry Identity

NPI1154993004
Entity TypeIndividualFemale
Primary Taxonomy101YA0400X
Provider Legal NameLISA JOSEPHINE DESTEFANOCredential: MA
Location Address1607 EXECUTIVE AVEMyrtle Beach, SC 29577-6501
Mailing Address4600 Montgomery Rd Ste 400Cincinnati, OH 45212-2600
Phone(843) 712-7316
Fax(843) 945-1022
Sole ProprietorNo
Enumeration DateJuly 12, 2021
Last NPPES UpdateOctober 1, 20262 updates tracked since enumeration
NPPES CertifiedOctober 1, 2026
✔ NPI 1154993004 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyCounselor · Addiction (Substance Use Disorder)Behavioral Health & Social Service Providers
Taxonomy Code101YA0400X
License✔ Licensed in SC · ADC-IP3071
Also ListedCounselor · Mental HealthTaxonomy 101YM0800X
1607 EXECUTIVE AVE, Myrtle Beach, SC 29577
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Secondary Practice Location 1

Location 11035 Cheraw StBennettsville, SC 29512-2422 · Phone (843) 454-0841 · Fax (843) 454-0635

Other Providers at the Same Location NPPES 8

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

AMY PETERSON
Licensed Practical Nurse
1607 EXECUTIVE AVE
MYRTLE BEACH, SC 29577
Horry County (843) 712-7316
MEAGAN HILBURN FNP-C
Nurse Practitioner (Family)
1607 EXECUTIVE AVE
MYRTLE BEACH, SC 29577
Horry County (843) 712-7316
BLAKE ELIZABETH THOMPSON ADC-IP
Counselor (Addiction (Substance Use Disorder))
1607 EXECUTIVE AVE
MYRTLE BEACH, SC 29577
Horry County (843) 712-7316
TIFFANY CLARK PHARMACY TECHNICIAN
Pharmacy Technician
1607 EXECUTIVE AVE
MYRTLE BEACH, SC 29577
Horry County (843) 712-7316
KELLY LYNN UNDERWOOD
Counselor (Addiction (Substance Use Disorder))
1607 EXECUTIVE AVE
MYRTLE BEACH, SC 29577
Horry County (843) 712-7316
KEVIN ALEXANDER CALDWELL
Counselor (Addiction (Substance Use Disorder))
1607 EXECUTIVE AVE
MYRTLE BEACH, SC 29577
Horry County (843) 712-7316
BOBBY WAYNE JORDAN ADC
Counselor (Addiction (Substance Use Disorder))
1607 EXECUTIVE AVE
MYRTLE BEACH, SC 29577
Horry County (843) 712-7316
MYRTLE BEACH TREATMENT SPECIALISTS LLC
Clinic/Center (Methadone)
1607 EXECUTIVE AVE
MYRTLE BEACH, SC 29577
Horry County (843) 712-7316

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Lisa Destefano's NPI number?

The NPI number for Lisa Destefano is 1154993004. It was assigned to this individual provider in the NPPES registry on July 12, 2021.

Where is Lisa Destefano located?

Lisa Destefano practices at 1607 Executive Ave, Myrtle Beach, SC 29577. The listed phone number is (843) 712-7316.

What is Lisa Destefano's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Addiction (Substance Use Disorder), with taxonomy code 101YA0400X.

When was this NPI record last updated?

The NPPES record for Lisa Destefano was last updated on October 1, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.