Healthcare Provider Details

I. General information

NPI: 1447413471
Provider Name (Legal Business Name): PETER H LEWIS PSYD, MSCP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 NNPTC CIR BLDG 2418
GOOSE CREEK SC
29445-6314
US

IV. Provider business mailing address

110 NNPTC CIR BLDG 2418
GOOSE CREEK SC
29445-6314
US

V. Phone/Fax

Practice location:
  • Phone: 843-794-6450
  • Fax: 843-794-6088
Mailing address:
  • Phone: 843-794-6450
  • Fax: 843-794-6088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number1714
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1234
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: