Healthcare Provider Details

I. General information

NPI: 1316864879
Provider Name (Legal Business Name): LESA LEWIS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3899 HERITAGE OAKS DR SW
POWDER SPRINGS GA
30127-9204
US

IV. Provider business mailing address

3899 HERITAGE OAKS DR SW
POWDER SPRINGS GA
30127-9204
US

V. Phone/Fax

Practice location:
  • Phone: 770-799-8690
  • Fax:
Mailing address:
  • Phone: 770-799-8690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW009887
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number006045
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: