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General NPI Number Information
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NPI Number | 1194609875
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Entity Type | Individual
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Provider Name | ROSA LEWIS
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Gender | Female
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Dates
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Enumeration Date | 08/04/2025
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Last Update Date | 09/05/2025
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Provider Practice Location Address
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Address Line | 15560 JOY RD
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City | DETROIT
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State | MI
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Zip | 48228-8200
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Country | US
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Telephone | 313-668-9300
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Fax |
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Provider Business Mailing Address
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Address Line | 20309 FENMORE ST
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City | DETROIT
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State | MI
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Zip | 48235-2295
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Country | US
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Telephone | 313-515-5586
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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 | 101Y00000X
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Taxonomy Name | 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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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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 | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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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 | 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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