Healthcare Provider Details

I. General information

NPI: 1114427770
Provider Name (Legal Business Name): MRS. MELISSA SARAH LEWIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. MELISSA SARAH MORRISSEY

II. Dates (important events)

Enumeration Date: 02/20/2018
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1671 GOSHEN RD APT I7
AUGUSTA GA
30906-9350
US

IV. Provider business mailing address

1671 GOSHEN RD APT I7
AUGUSTA GA
30906-9350
US

V. Phone/Fax

Practice location:
  • Phone: 860-597-2534
  • Fax:
Mailing address:
  • Phone: 860-597-2534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14433
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW010209
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14433
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCSW010209
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number14433
License Number StateCT
# 6
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number14433
License Number StateCT
# 7
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCSW010209
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: