Provider Demographics
NPI:1063158707
Name:LEWIS, BENITA EDRENA (PHD, LCMHC, NCC)
Entity type:Individual
Prefix:DR
First Name:BENITA
Middle Name:EDRENA
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PHD, LCMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 NC HIGHWAY 61 UNIT 201
Mailing Address - Street 2:
Mailing Address - City:WHITSETT
Mailing Address - State:NC
Mailing Address - Zip Code:27377-0139
Mailing Address - Country:US
Mailing Address - Phone:336-706-0391
Mailing Address - Fax:
Practice Address - Street 1:4108 ALAMANCE RD # 5
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-9391
Practice Address - Country:US
Practice Address - Phone:336-706-0391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-06
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA14214101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health