Healthcare Provider Details

I. General information

NPI: 1922172238
Provider Name (Legal Business Name): MICHELLE W LEWIS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 08/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 HEALTH CENTER DR
AHOSKIE NC
27910-8161
US

IV. Provider business mailing address

PO BOX 669
AHOSKIE NC
27910-0669
US

V. Phone/Fax

Practice location:
  • Phone: 252-332-3548
  • Fax: 252-332-1665
Mailing address:
  • Phone: 252-209-0237
  • Fax: 252-209-0197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC004744
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: