Healthcare Provider Details

I. General information

NPI: 1568772366
Provider Name (Legal Business Name): ANNJEANEN TRISA LEWIS LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2010
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 GWINNETT DR
LAWRENCEVILLE GA
30046-5671
US

IV. Provider business mailing address

311 GWINNETT DR
LAWRENCEVILLE GA
30046-5671
US

V. Phone/Fax

Practice location:
  • Phone: 770-910-9196
  • Fax:
Mailing address:
  • Phone: 770-910-9196
  • Fax: 513-558-3100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE0500102
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: