Healthcare Provider Details

I. General information

NPI: 1245756535
Provider Name (Legal Business Name): LISA DARLENE LEWIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2017
Last Update Date: 08/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 5TH ST
SAINT CLOUD FL
34769-2024
US

IV. Provider business mailing address

3800 5TH ST
SAINT CLOUD FL
34769-2024
US

V. Phone/Fax

Practice location:
  • Phone: 407-892-5700
  • Fax: 407-593-2932
Mailing address:
  • Phone: 407-892-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: