Provider Demographics
NPI:1396526877
Name:LEWIS, KRISTEN PAIGE (LCSW)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:PAIGE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 MOORLAND WAY
Mailing Address - Street 2:
Mailing Address - City:MOYOCK
Mailing Address - State:NC
Mailing Address - Zip Code:27958-6506
Mailing Address - Country:US
Mailing Address - Phone:757-285-5433
Mailing Address - Fax:
Practice Address - Street 1:229 MOORLAND WAY
Practice Address - Street 2:
Practice Address - City:MOYOCK
Practice Address - State:NC
Practice Address - Zip Code:27958-6506
Practice Address - Country:US
Practice Address - Phone:757-285-5433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0154071041C0700X
VAVA09040137471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical