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General NPI Number Information
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NPI Number | 1124988381
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Entity Type | Organization
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Legal Business Name | GUARDIAN ALLIES COLLECTIVE LLC
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Dates
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Enumeration Date | 11/12/2025
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Last Update Date | 12/11/2025
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Provider Practice Location Address
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Address Line | 2155 N PARK LN STE 216
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City | NORTH CHARLESTON
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State | SC
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Zip | 29406-9261
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Country | US
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Telephone | 843-969-0297
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Fax | 854-258-5167
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Provider Business Mailing Address
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Address Line | 6565 WARD PKWY
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City | MELBOURNE
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State | FL
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Zip | 32904-3636
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Country | US
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Telephone | 904-472-6050
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Fax | 854-258-5167
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | DR. PAULA MICHELLE LEWIS
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Credential | ED.D., LPES
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Telephone | 904-472-6050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TH0100X
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Taxonomy Name | Health Service Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103TM1800X
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Taxonomy Name | Intellectual & Developmental Disabilities Psychologist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number |
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License Number State |
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