Provider Demographics
NPI:1821876509
Name:LEWIS, LATASHA CHRISTINA (LCSW)
Entity Type:Individual
Prefix:
First Name:LATASHA
Middle Name:CHRISTINA
Last Name: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:PO BOX 363
Mailing Address - Street 2:
Mailing Address - City:PAINCOURTVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70391-0363
Mailing Address - Country:US
Mailing Address - Phone:985-335-5061
Mailing Address - Fax:
Practice Address - Street 1:59595 BELLEVIEW RD
Practice Address - Street 2:
Practice Address - City:PLAQUEMINE
Practice Address - State:LA
Practice Address - Zip Code:70764-6500
Practice Address - Country:US
Practice Address - Phone:225-401-4313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA106871041S0200X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchoolGroup - Multi-Specialty