Healthcare Provider Details

I. General information

NPI: 1629449731
Provider Name (Legal Business Name): ABIGAIL LEWIS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2015
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30472 23 MILE RD
CHESTERFIELD MI
48047-1844
US

IV. Provider business mailing address

30472 23 MILE RD
CHESTERFIELD MI
48047-1844
US

V. Phone/Fax

Practice location:
  • Phone: 586-863-4000
  • Fax: 586-863-4004
Mailing address:
  • Phone: 586-863-4000
  • Fax: 586-863-4004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801091213
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: