Provider Demographics
NPI:1770318537
Name:LEWIS, GWENDOLYN PARHAM (LMPC-R)
Entity type:Individual
Prefix:MS
First Name:GWENDOLYN
Middle Name:PARHAM
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LMPC-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14422 HUNTING QUARTER CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:STONY CREEK
Mailing Address - State:VA
Mailing Address - Zip Code:23882-3419
Mailing Address - Country:US
Mailing Address - Phone:434-594-8365
Mailing Address - Fax:
Practice Address - Street 1:14422 HUNTING QUARTER CHURCH RD
Practice Address - Street 2:
Practice Address - City:STONY CREEK
Practice Address - State:VA
Practice Address - Zip Code:23882-3419
Practice Address - Country:US
Practice Address - Phone:434-594-8365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704014884101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health