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General NPI Number Information
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NPI Number | 1427471812
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Entity Type | Individual
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Provider Name | CRYSTAL LEWIS LMSW
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Gender | Female
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Dates
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Enumeration Date | 01/21/2014
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Last Update Date | 01/21/2014
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Provider Practice Location Address
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Address Line | 901 SENOIA RD
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City | TYRONE
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State | GA
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Zip | 30290-2065
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Country | US
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Telephone | 334-328-4898
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Fax |
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Provider Business Mailing Address
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Address Line | 4010 RIVERCHESS DR SW
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City | ATLANTA
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State | GA
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Zip | 30331-6016
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Country | US
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Telephone | 334-328-4898
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | MSW005863
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License Number State | GA
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