Provider Demographics
NPI:1407385883
Name:LEWIS, LANA (LCDCIII)
Entity Type:Individual
Prefix:
First Name:LANA
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LCDCIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 S SAINT CLAIR ST
Mailing Address - Street 2:
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-3421
Mailing Address - Country:US
Mailing Address - Phone:440-276-1199
Mailing Address - Fax:
Practice Address - Street 1:134 STCLAIR STREET
Practice Address - Street 2:
Practice Address - City:PAINSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077
Practice Address - Country:US
Practice Address - Phone:440-276-1199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH131111101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)