Healthcare Provider Details

I. General information

NPI: 1164859773
Provider Name (Legal Business Name): SARAH ANNE LEWIS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2013
Last Update Date: 09/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4376 LANKFORD HWY SUITE 2
EXMORE VA
23350-2308
US

IV. Provider business mailing address

4376 LANKFORD HWY SUITE 2
EXMORE VA
23350-2308
US

V. Phone/Fax

Practice location:
  • Phone: 757-442-6746
  • Fax: 757-442-6749
Mailing address:
  • Phone: 757-442-6746
  • Fax: 757-442-6749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701005593
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC5016
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: