Healthcare Provider Details

I. General information

NPI: 1801607221
Provider Name (Legal Business Name): OPHELIA LEWIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2025
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 FORBES BLVD STE 103
LANHAM MD
20706-4390
US

IV. Provider business mailing address

826 ALAMITOS AVE UNIT B
LONG BEACH CA
90813-4793
US

V. Phone/Fax

Practice location:
  • Phone: 301-781-7885
  • Fax:
Mailing address:
  • Phone: 562-285-8392
  • 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: