Provider Demographics
NPI:1164745048
Name:LEWIS, GREGORY KENNETH (MA-LMFT)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:KENNETH
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MA-LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8325 HOPKINS RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23237-2501
Mailing Address - Country:US
Mailing Address - Phone:804-241-2153
Mailing Address - Fax:
Practice Address - Street 1:8325 HOPKINS RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23237-2501
Practice Address - Country:US
Practice Address - Phone:804-241-2153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0717001216106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist