Healthcare Provider Details

I. General information

NPI: 1396511317
Provider Name (Legal Business Name): OLIVIA MICHELLE LEWIS MS, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2023
Last Update Date: 11/30/2023
Certification Date: 11/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6330 N CENTER DRIVE BUILDING 13 SUITE 200
NORFOLK VA
23502
US

IV. Provider business mailing address

1607 WEBER AVE APT 3
CHESAPEAKE VA
23325-4228
US

V. Phone/Fax

Practice location:
  • Phone: 757-233-0003
  • Fax: 757-233-1669
Mailing address:
  • Phone: 757-793-1633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701012882
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: