Healthcare Provider Details

I. General information

NPI: 1265249544
Provider Name (Legal Business Name): NAKIA LEWIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2024
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

738 WOODLAWN DR NE
MARIETTA GA
30068-4253
US

IV. Provider business mailing address

3865 WILLOW RIDGE RD
DOUGLASVILLE GA
30135-2786
US

V. Phone/Fax

Practice location:
  • Phone: 770-726-9589
  • Fax:
Mailing address:
  • Phone: 404-987-2029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: