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General NPI Number Information
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NPI Number | 1184714982
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Entity Type | Individual
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Provider Name | MARCELLA A LEWIS LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 10/30/2008
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Provider Practice Location Address
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Address Line | 2375 MEMPHIS ST SUITE 208
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City | HERNANDO
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State | MS
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Zip | 38632-1756
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Country | US
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Telephone | 901-230-0622
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Fax | 662-449-0422
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Provider Business Mailing Address
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Address Line | 2375 MEMPHIS ST SUITE 208
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City | HERNANDO
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State | MS
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Zip | 38632-1756
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Country | US
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Telephone | 901-230-0622
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Fax | 662-449-0422
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 00688
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License Number State | TN
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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 | C7256
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License Number State | MS
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