Provider Demographics
NPI:1073166708
Name:LEWIS, KAREN (LPCA)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1064 COTTINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3552
Mailing Address - Country:US
Mailing Address - Phone:843-714-5260
Mailing Address - Fax:
Practice Address - Street 1:207 SIMMONS ST
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-4347
Practice Address - Country:US
Practice Address - Phone:843-714-5260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6775101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health