Provider Demographics
NPI:1568981959
Name:MAYO-LEWIS, KISHA MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:KISHA
Middle Name:MARIE
Last Name:MAYO-LEWIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 D ST
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23324-2523
Mailing Address - Country:US
Mailing Address - Phone:757-289-0616
Mailing Address - Fax:
Practice Address - Street 1:217 D ST
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23324-2523
Practice Address - Country:US
Practice Address - Phone:757-289-0616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040098311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical