Provider Demographics
NPI:1952916058
Name:FONDA LEWIS INSIGHTFUL COUNSELING, PLLC
Entity Type:Organization
Organization Name:FONDA LEWIS INSIGHTFUL COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:FONDA
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LCPC, NCC
Authorized Official - Phone:847-975-6294
Mailing Address - Street 1:4227 N SALEM DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-7902
Mailing Address - Country:US
Mailing Address - Phone:847-975-6294
Mailing Address - Fax:
Practice Address - Street 1:4227 N SALEM DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-7902
Practice Address - Country:US
Practice Address - Phone:847-975-6294
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty