Provider Demographics
NPI:1942728654
Name:HEWITT, TAWANDA RONEA
Entity Type:Individual
Prefix:
First Name:TAWANDA
Middle Name:RONEA
Last Name:HEWITT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 CORA LEE LN
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-5242
Mailing Address - Country:US
Mailing Address - Phone:606-802-6112
Mailing Address - Fax:
Practice Address - Street 1:321 RINGGOLD RD
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-3900
Practice Address - Country:US
Practice Address - Phone:606-451-1936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-01
Last Update Date:2017-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH$$$$$$$$$Medicaid