Provider Demographics
NPI:1295494631
Name:LEWIS, HADIYAH SIMONE (LPCA)
Entity type:Individual
Prefix:
First Name:HADIYAH
Middle Name:SIMONE
Last Name:LEWIS
Suffix:
Gender:
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7901 FARROW RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-3220
Mailing Address - Country:US
Mailing Address - Phone:803-529-8894
Mailing Address - Fax:
Practice Address - Street 1:137 ROSEBERRY LN APT 2215
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-2866
Practice Address - Country:US
Practice Address - Phone:803-529-8894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-13
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9306101YM0800X, 101YP2500X
SC7858101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health