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General NPI Number Information
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NPI Number | 1114967056
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Entity Type | Individual
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Provider Name | RICHARD MARK LEWIS PHD
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Gender | Male
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Dates
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Enumeration Date | 06/08/2006
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Last Update Date | 08/13/2021
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Provider Practice Location Address
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Address Line | 719 GREEN VALLEY RD STE 306
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City | GREENSBORO
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State | NC
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Zip | 27408-7026
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Country | US
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Telephone | 336-275-6470
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Fax | 336-275-6474
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Provider Business Mailing Address
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Address Line | 1200 N ELM ST
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City | GREENSBORO
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State | NC
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Zip | 27401-1004
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Country | US
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Telephone |
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 1779
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License Number State | NC
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