Provider Demographics
NPI:1154185049
Name:LEWIS, VIVA S (MA, LPC)
Entity type:Individual
Prefix:
First Name:VIVA
Middle Name:S
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:356 LAKE MURRAY BLVD APT 218
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-7646
Mailing Address - Country:US
Mailing Address - Phone:980-748-6248
Mailing Address - Fax:
Practice Address - Street 1:356 LAKE MURRAY BLVD APT 218
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-7646
Practice Address - Country:US
Practice Address - Phone:980-748-6248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8841101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health