Healthcare Provider Details

I. General information

NPI: 1033943519
Provider Name (Legal Business Name): ASHANTI LEWIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2024
Last Update Date: 08/28/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 MILLET HALL
DAYTON OH
45435-0001
US

IV. Provider business mailing address

2708 ALLEGHENY AVE
COLUMBUS OH
43209-1012
US

V. Phone/Fax

Practice location:
  • Phone: 937-775-3490
  • Fax:
Mailing address:
  • Phone: 614-975-6197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: