Provider Demographics
NPI:1336216944
Name:LEWIS-WELLS, LORETTA LOUISE (LPCC-S, LISW-S)
Entity Type:Individual
Prefix:MS
First Name:LORETTA
Middle Name:LOUISE
Last Name:LEWIS-WELLS
Suffix:
Gender:F
Credentials:LPCC-S, LISW-S
Other - Prefix:MS
Other - First Name:LORETTA
Other - Middle Name:LOUISE
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17273 STATE ROUTE 104
Mailing Address - Street 2:BUILDING 24CD
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601
Mailing Address - Country:US
Mailing Address - Phone:740-773-1141
Mailing Address - Fax:740-772-7187
Practice Address - Street 1:17273 STATE ROUTE 104
Practice Address - Street 2:CHILLICOTHE VAMC, BUILDING 24CD
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-9718
Practice Address - Country:US
Practice Address - Phone:740-773-1141
Practice Address - Fax:740-772-7187
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE-0001762-SUPV101YP2500X
OHI-0700266-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional