Healthcare Provider Details

I. General information

NPI: 1952058893
Provider Name (Legal Business Name): ALYSSA LEWIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2022
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 CHERRY LN # CA
MANTECA CA
95337-4311
US

IV. Provider business mailing address

1900 EMBARCADERO STE 303
OAKLAND CA
94606-5227
US

V. Phone/Fax

Practice location:
  • Phone: 209-465-1080
  • Fax:
Mailing address:
  • Phone: 209-647-6200
  • Fax: 209-647-6210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: