Provider Demographics
NPI:1326570854
Name:LEWIS, KIMBERLY D (MA, LPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:D
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:DAWN
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, NCC
Mailing Address - Street 1:235 LIGHT SPRING RD
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29642-1766
Mailing Address - Country:US
Mailing Address - Phone:864-549-6191
Mailing Address - Fax:
Practice Address - Street 1:235 LIGHT SPRING RD
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29642-1766
Practice Address - Country:US
Practice Address - Phone:864-549-6191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-03
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7398101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional