Provider Demographics
NPI:1679827224
Name:NEVINS, LEWIS J (PCC)
Entity Type:Individual
Prefix:
First Name:LEWIS
Middle Name:J
Last Name:NEVINS
Suffix:
Gender:M
Credentials:PCC
Other - Prefix:
Other - First Name:LEWIS
Other - Middle Name:J
Other - Last Name:NEVINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PCC
Mailing Address - Street 1:1948 E WHIPP RD
Mailing Address - Street 2:SUITE A1
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45440-4240
Mailing Address - Country:US
Mailing Address - Phone:937-434-6217
Mailing Address - Fax:937-434-6375
Practice Address - Street 1:1948 E WHIPP RD
Practice Address - Street 2:SUITE A1
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45440-4240
Practice Address - Country:US
Practice Address - Phone:937-434-6217
Practice Address - Fax:937-434-6375
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-05
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0800290101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor