Provider Demographics
NPI:1679665186
Name:LEWIS, STARLENE F (LPCC, LICDC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:STARLENE
Middle Name:F
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LPCC, LICDC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15525 GROVE RD SE
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43837-9017
Mailing Address - Country:US
Mailing Address - Phone:740-498-7213
Mailing Address - Fax:
Practice Address - Street 1:710 MAIN ST
Practice Address - Street 2:
Practice Address - City:COSHOCTON
Practice Address - State:OH
Practice Address - Zip Code:43812-1615
Practice Address - Country:US
Practice Address - Phone:740-622-3404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH001241101YA0400X
OH228661101Y00000X
OHE0007952101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor