Provider Demographics
NPI:1255404489
Name:LEWIS, LORISA P (MS, LMHC)
Entity type:Individual
Prefix:
First Name:LORISA
Middle Name:P
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001 BRICK CT
Mailing Address - Street 2:SUITE 109
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-9425
Mailing Address - Country:US
Mailing Address - Phone:407-672-0300
Mailing Address - Fax:407-672-0408
Practice Address - Street 1:6001 BRICK CT
Practice Address - Street 2:SUITE 109
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-9425
Practice Address - Country:US
Practice Address - Phone:407-672-0300
Practice Address - Fax:407-672-0408
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1755101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health