Healthcare Provider Details

I. General information

NPI: 1154872117
Provider Name (Legal Business Name): FAITH H LEWIS-FOSTER LISW, LICDC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2016
Last Update Date: 12/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9083 MENTOR AVE
MENTOR OH
44060-6462
US

IV. Provider business mailing address

9083 MENTOR AVE
MENTOR OH
44060-6462
US

V. Phone/Fax

Practice location:
  • Phone: 440-205-2665
  • Fax:
Mailing address:
  • Phone: 440-205-2665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number151002
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS1302707
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: