Provider Demographics
NPI:1225662018
Name:LEWIS, AMANDA FAYE (LPC)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:FAYE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6825 LAKE RD
Mailing Address - Street 2:
Mailing Address - City:PRINCE GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:23875-4631
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9407 CUMBERLAND RD
Practice Address - Street 2:
Practice Address - City:NEW KENT
Practice Address - State:VA
Practice Address - Zip Code:23124-2029
Practice Address - Country:US
Practice Address - Phone:804-966-2242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-02
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008352101Y00000X
VA101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor