Healthcare Provider Details

I. General information

NPI: 1275343733
Provider Name (Legal Business Name): ELLICE LEWIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2025
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 FRANCIS ST # 24071
ANNAPOLIS MD
21401-1772
US

IV. Provider business mailing address

16 FRANCIS ST # 24071
ANNAPOLIS MD
21401-1772
US

V. Phone/Fax

Practice location:
  • Phone: 757-828-7337
  • Fax:
Mailing address:
  • Phone: 856-539-4790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number92598
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number92598
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number180017495
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number01465
License Number StateRI
# 7
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number92598
License Number StateTX
# 8
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number92598
License Number StateTX
# 9
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number37PC01184800
License Number StateNJ
# 10
Primary TaxonomyN
Taxonomy Code374K00000X
TaxonomyReligious Nonmedical Practitioner
License Number
License Number State
# 11
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number92598
License Number StateTX
# 12
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0701011952
License Number StateVA
# 13
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number92598
License Number StateTX
# 14
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number5887
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: