Healthcare Provider Details

I. General information

NPI: 1861250227
Provider Name (Legal Business Name): MELANIE YOLANDA LEWIS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2024
Last Update Date: 03/11/2024
Certification Date: 11/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8000 BROOK RD
RICHMOND VA
23227-1338
US

IV. Provider business mailing address

4152 JARRELLS WAY
BURR HILL VA
22433-9771
US

V. Phone/Fax

Practice location:
  • Phone: 804-553-3200
  • Fax:
Mailing address:
  • Phone: 540-223-1885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701012421
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: