Healthcare Provider Details

I. General information

NPI: 1275456667
Provider Name (Legal Business Name): DEVIN LEWIS D.TH, LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11123 ROCK GARDEN DR
FAIRFAX VA
22030-4935
US

IV. Provider business mailing address

11123 ROCK GARDEN DR
FAIRFAX VA
22030-4935
US

V. Phone/Fax

Practice location:
  • Phone: 240-603-9526
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLG200004541
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: