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General NPI Number Information
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NPI Number | 1255127098
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Entity Type | Individual
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Provider Name | KELLY MARIE RIVERA LEWIS LMFT
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Gender | Female
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Dates
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Enumeration Date | 04/17/2025
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Last Update Date | 04/17/2025
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Provider Practice Location Address
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Address Line | 112 CANDLEWOOD CT
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City | LYNCHBURG
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State | VA
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Zip | 24502-2653
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Country | US
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Telephone | 434-258-0591
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Fax |
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Provider Business Mailing Address
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Address Line | 104 MAPLE HILLS DR UNIT B
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City | LYNCHBURG
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State | VA
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Zip | 24502-4420
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Country | US
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Telephone | 614-306-0694
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 0717002392
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 20725
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License Number State | NC
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