Healthcare Provider Details

I. General information

NPI: 1235194564
Provider Name (Legal Business Name): DEBORAH K LEWIS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 07/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 70TH ST S
ST PETERSBURG FL
33707-1220
US

IV. Provider business mailing address

PO BOX 1278
LINCOLNTON NC
28093-1278
US

V. Phone/Fax

Practice location:
  • Phone: 727-388-1661
  • Fax: 727-800-2333
Mailing address:
  • Phone: 727-388-1661
  • Fax: 727-800-2333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1075
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH3245
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: