Provider Demographics
NPI:1144853003
Name:WARD-LEWIS, CARMEN NIKITA (BA, MA, LPC, NCC)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:NIKITA
Last Name:WARD-LEWIS
Suffix:
Gender:F
Credentials:BA, MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2404 KNIGHTWAY DR
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-3043
Mailing Address - Country:US
Mailing Address - Phone:504-638-0001
Mailing Address - Fax:
Practice Address - Street 1:1901 MANHATTAN BLVD, BUILDING D, SUITE 104
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058
Practice Address - Country:US
Practice Address - Phone:504-372-6241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-19
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5778101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty