Healthcare Provider Details

I. General information

NPI: 1942433792
Provider Name (Legal Business Name): DAWN T LEWIS MS, LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2009
Last Update Date: 09/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 W CHESAPEAKE AVE
TOWSON MD
21204-4405
US

IV. Provider business mailing address

304 W CHESAPEAKE AVE
TOWSON MD
21204-4405
US

V. Phone/Fax

Practice location:
  • Phone: 443-632-8814
  • Fax:
Mailing address:
  • Phone: 443-632-8814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC4446
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC4446
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLC4446
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: