Healthcare Provider Details

I. General information

NPI: 1083577753
Provider Name (Legal Business Name): CHARISSEE JENA LEWIS DOCTORATE OF DIVINIT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5727 ROYAL WOOD
WEST BLOOMFIELD MI
48322-2069
US

IV. Provider business mailing address

5727 ROYAL WOOD
WEST BLOOMFIELD MI
48322-2069
US

V. Phone/Fax

Practice location:
  • Phone: 313-544-8010
  • Fax:
Mailing address:
  • Phone: 313-544-8010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: