Healthcare Provider Details

I. General information

NPI: 1982907903
Provider Name (Legal Business Name): MARC TODD LEWIS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MARC TODD LEWIS LCSW, LCAS, CCM, BCD

II. Dates (important events)

Enumeration Date: 12/14/2010
Last Update Date: 09/19/2021
Certification Date: 09/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 DAVIS ST STE D
ASHEBORO NC
27203-5485
US

IV. Provider business mailing address

288 WATERFRONT CT
ASHEBORO NC
27203-3000
US

V. Phone/Fax

Practice location:
  • Phone: 336-625-8594
  • Fax: 336-217-7972
Mailing address:
  • Phone: 336-625-8594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC007342
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: