Provider Demographics
NPI:1801028352
Name:JOHNSON LEWIS, KENIA (PHD)
Entity Type:Individual
Prefix:
First Name:KENIA
Middle Name:
Last Name:JOHNSON LEWIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:KENIA
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:560 THORNTON RD
Mailing Address - Street 2:STE. 106
Mailing Address - City:LITHIA SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30122-1655
Mailing Address - Country:US
Mailing Address - Phone:770-732-0982
Mailing Address - Fax:770-732-1283
Practice Address - Street 1:560 THORNTON RD
Practice Address - Street 2:STE. 106
Practice Address - City:LITHIA SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30122-1655
Practice Address - Country:US
Practice Address - Phone:770-732-0982
Practice Address - Fax:770-732-1283
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-18
Last Update Date:2024-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003304103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical