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General NPI Number Information
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NPI Number | 1083475578
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Entity Type | Individual
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Provider Name | REGINA S WILCOX-LEWIS LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/22/2024
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Last Update Date | 05/14/2024
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Provider Practice Location Address
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Address Line | 140 CARL CIR
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City | BYRAM
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State | MS
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Zip | 39272-4507
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Country | US
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Telephone | 601-946-0369
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Fax |
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Provider Business Mailing Address
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Address Line | 350 W WOODROW WILSON AVE
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City | JACKSON
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State | MS
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Zip | 39213-7681
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Country | US
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Telephone | 601-815-3305
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C11021
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License Number State | MS
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