Healthcare Provider Details

I. General information

NPI: 1538556923
Provider Name (Legal Business Name): LEWIS CHASE II LBSW, CADC-M
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2015
Last Update Date: 08/30/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6215 MAKSIMOWSKI AVE NE
BELMONT MI
49306-9700
US

IV. Provider business mailing address

6215 MAKSIMOWSKI AVE NE
BELMONT MI
49306-9700
US

V. Phone/Fax

Practice location:
  • Phone: 269-350-1383
  • Fax:
Mailing address:
  • Phone: 269-350-1383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1-00898
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6802065813
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: