Healthcare Provider Details

I. General information

NPI: 1083965107
Provider Name (Legal Business Name): TERRICKA RENEE LEWIS M.A. LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2012
Last Update Date: 03/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9333 TELEGRAPH RD
TAYLOR MI
48180-3386
US

IV. Provider business mailing address

9333 TELEGRAPH RD
TAYLOR MI
48180-3386
US

V. Phone/Fax

Practice location:
  • Phone: 313-406-4493
  • Fax:
Mailing address:
  • Phone: 313-406-4493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401012926
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: