Healthcare Provider Details

I. General information

NPI: 1609226380
Provider Name (Legal Business Name): LISA LEWIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2016
Last Update Date: 01/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 LAKEVIEW COURT
MCHENRY MD
21541
US

IV. Provider business mailing address

PO BOX 194
MC HENRY MD
21541-0194
US

V. Phone/Fax

Practice location:
  • Phone: 301-876-7520
  • Fax:
Mailing address:
  • Phone: 301-876-7520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC6871
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: