Provider Demographics
NPI:1801512769
Name:PREWITT, LISA MICHELLE (LPCA)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MICHELLE
Last Name:PREWITT
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 155
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:KY
Mailing Address - Zip Code:40050-0155
Mailing Address - Country:US
Mailing Address - Phone:502-432-2011
Mailing Address - Fax:
Practice Address - Street 1:4010 DUPONT CIR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4812
Practice Address - Country:US
Practice Address - Phone:502-432-2011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY275692101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health