Provider Demographics
NPI:1306733837
Name:LEWIS, MELANIE (LCDC III)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LCDC III
Other - Prefix:MRS
Other - First Name:MELANIE
Other - Middle Name:
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCDC III
Mailing Address - Street 1:7643 OSCEOLA RD
Mailing Address - Street 2:
Mailing Address - City:BLANCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45107-7508
Mailing Address - Country:US
Mailing Address - Phone:513-903-7623
Mailing Address - Fax:
Practice Address - Street 1:25 WHITNEY DR STE 120
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-8400
Practice Address - Country:US
Practice Address - Phone:513-654-2773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH071034101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty