| NPI | 1255127098 |
|---|---|
| Former Name | KELLY MARIE LEWIS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: VA 0717002392) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NC 20725) |
| Enumeration Date | 2025-04-17 |
| Last Update Date | 2025-04-17 |