Healthcare Provider Details

I. General information

NPI: 1275437204
Provider Name (Legal Business Name): LISA M. LEWIS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 RESEARCH DR
ATHENS GA
30605-2750
US

IV. Provider business mailing address

5175 OLD LEXINGTON RD
ATHENS GA
30605-5033
US

V. Phone/Fax

Practice location:
  • Phone: 706-705-2881
  • Fax: 888-334-4283
Mailing address:
  • Phone: 706-386-7356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC017505
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: