Healthcare Provider Details

I. General information

NPI: 1619632825
Provider Name (Legal Business Name): MONIQUE D LEWIS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2021
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1776 G ST NW
WASHINGTON DC
20006-4705
US

IV. Provider business mailing address

1001 CONNECTICUT AVE NW
WASHINGTON DC
20036-5504
US

V. Phone/Fax

Practice location:
  • Phone: 404-273-0311
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberPSYA00441
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: