Provider Demographics
NPI:1649356965
Name:AVIS, RENEE MULFORD-LEWIS (LPC)
Entity type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:MULFORD-LEWIS
Last Name:AVIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 NORTHINGTON PL
Mailing Address - Street 2:APT. E
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-9651
Mailing Address - Country:US
Mailing Address - Phone:919-272-3799
Mailing Address - Fax:
Practice Address - Street 1:103 KILMAYNE DR STE C
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-4425
Practice Address - Country:US
Practice Address - Phone:919-272-3799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-29
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5383101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional