Healthcare Provider Details

I. General information

NPI: 1225662018
Provider Name (Legal Business Name): AMANDA FAYE LEWIS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2020
Last Update Date: 09/20/2023
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9407 CUMBERLAND RD
NEW KENT VA
23124-2029
US

IV. Provider business mailing address

6825 LAKE RD
PRINCE GEORGE VA
23875-4631
US

V. Phone/Fax

Practice location:
  • Phone: 804-966-2242
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0701008352
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: