Provider Demographics
NPI:1306310602
Name:LEWIS, KATHRYN O (MS, LPC)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:O
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:I
Other - Last Name:OGDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8221 WILLOW OAKS CORPORATE DR # 4-420
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4512
Mailing Address - Country:US
Mailing Address - Phone:914-255-2204
Mailing Address - Fax:
Practice Address - Street 1:8221 WILLOW OAKS CORPORATE DR STE 4-420
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4512
Practice Address - Country:US
Practice Address - Phone:571-623-3500
Practice Address - Fax:703-204-9001
Is Sole Proprietor?:No
Enumeration Date:2019-01-20
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008130101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor