Healthcare Provider Details

I. General information

NPI: 1902319379
Provider Name (Legal Business Name): VERONICA KELLY-LEWIS BA, MS.ED. QMHS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2017
Last Update Date: 10/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8532 MENTOR AVE
MENTOR OH
44060-5822
US

IV. Provider business mailing address

8532 MENTOR AVE
MENTOR OH
44060-5822
US

V. Phone/Fax

Practice location:
  • Phone: 440-205-1008
  • Fax: 440-205-1047
Mailing address:
  • Phone: 440-205-1008
  • Fax: 440-205-1047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number167140
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: