Healthcare Provider Details

I. General information

NPI: 1710707948
Provider Name (Legal Business Name): MONICA LEWIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2024
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 MCDOWELL ST
SAINT MARYS GA
31558-9050
US

IV. Provider business mailing address

4828 ASHFORD DUNWOODY RD STE 300
ATLANTA GA
30338-4833
US

V. Phone/Fax

Practice location:
  • Phone: 770-238-2674
  • Fax:
Mailing address:
  • Phone: 404-951-6020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: