Healthcare Provider Details

I. General information

NPI: 1366186785
Provider Name (Legal Business Name): KATHERINE B LEWIS LPC, ICADC II, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2022
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 W JACKSON ST
RIDGELAND MS
39157-2312
US

IV. Provider business mailing address

409 HERNDON RD
LEAKESVILLE MS
39451-5159
US

V. Phone/Fax

Practice location:
  • Phone: 601-525-6093
  • Fax:
Mailing address:
  • Phone: 601-525-6093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3080
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberAD18-019L
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1625790
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: