Healthcare Provider Details

I. General information

NPI: 1437334067
Provider Name (Legal Business Name): THERESA LEWIS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2008
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4917 WATERS EDGE DR STE 220
RALEIGH NC
27606-2459
US

IV. Provider business mailing address

PO BOX 1955
CARY NC
27512-1955
US

V. Phone/Fax

Practice location:
  • Phone: 919-622-1303
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number2866
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2866
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number2866
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: