Provider Demographics
NPI:1396511317
Name:LEWIS, OLIVIA MICHELLE (MS, LPC)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:MICHELLE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 WEBER AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23325-4228
Mailing Address - Country:US
Mailing Address - Phone:757-793-1633
Mailing Address - Fax:
Practice Address - Street 1:6330 N CENTER DRIVE
Practice Address - Street 2:BUILDING 13 SUITE 200
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502
Practice Address - Country:US
Practice Address - Phone:757-233-0003
Practice Address - Fax:757-233-1669
Is Sole Proprietor?:No
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701012882101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health