Provider Demographics
NPI:1669230538
Name:LEWIS, VONNIE S (LPCA)
Entity type:Individual
Prefix:MRS
First Name:VONNIE
Middle Name:S
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:VONNIE
Other - Middle Name:J
Other - Last Name:SINGLETON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1503 GLENROCK RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40216-4033
Mailing Address - Country:US
Mailing Address - Phone:502-650-3541
Mailing Address - Fax:
Practice Address - Street 1:4502 FEGENBUSH LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40228-1133
Practice Address - Country:US
Practice Address - Phone:502-650-3541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-06
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY282368101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional