Healthcare Provider Details

I. General information

NPI: 1265198816
Provider Name (Legal Business Name): DAVID EDWARD LEWIS LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2021
Last Update Date: 03/10/2023
Certification Date: 03/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 N MILL ST
LITTLE MOUNTAIN SC
29075-8788
US

IV. Provider business mailing address

169 LAURELHURST AVE
COLUMBIA SC
29210-3825
US

V. Phone/Fax

Practice location:
  • Phone: 803-945-1005
  • Fax: 803-941-8180
Mailing address:
  • Phone: 803-733-5969
  • Fax: 803-753-5591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8448
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: