Individual
KENYATTA LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
3415 ROSEMARY AVE, JACKSON, MS 39212-4153
(601) 918-8712
Mailing address
3415 ROSEMARY AVE, JACKSON, MS 39212-4153
(601) 918-8712
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
C11502
MS
104100000X
Social Worker
Primary
M9161
MS
Other
Enumeration date
04/05/2021
Last updated
05/05/2026
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