Provider Demographics
NPI:1801924618
Name:LEWINSKI, JACLYN (PHD, LPC)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:LEWINSKI
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7417 BIG BND
Mailing Address - Street 2:
Mailing Address - City:WHITE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48383-4018
Mailing Address - Country:US
Mailing Address - Phone:629-777-6007
Mailing Address - Fax:615-679-3900
Practice Address - Street 1:7417 BIG BND
Practice Address - Street 2:
Practice Address - City:WHITE LAKE
Practice Address - State:MI
Practice Address - Zip Code:48383-4018
Practice Address - Country:US
Practice Address - Phone:629-777-6007
Practice Address - Fax:615-679-3900
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC8677101YP2500X, 101YM0800X
MI6401009499101YM0800X, 101YP2500X
TN2478101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health