Provider Demographics
NPI:1336707116
Name:LEWIS, KAYLA (LPCA)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5939 W FRIENDLY AVE APT 65E
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-3393
Mailing Address - Country:US
Mailing Address - Phone:910-574-3982
Mailing Address - Fax:
Practice Address - Street 1:3 CENTERVIEW DR STE 150
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-3728
Practice Address - Country:US
Practice Address - Phone:910-574-3982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA14491101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health