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General NPI Number Information
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NPI Number | 1487171914
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Entity Type | Individual
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Provider Name | DARRELL WILFORD LEWIS JR. MSW, CSW
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Gender | Male
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Dates
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Enumeration Date | 08/25/2017
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Last Update Date | 08/25/2017
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Provider Practice Location Address
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Address Line | 321 N MALL DRIVE STE. VW 101
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City | ST. GEORGE
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State | UT
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Zip | 84790
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Country | US
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Telephone | 435-319-0082
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Fax |
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Provider Business Mailing Address
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Address Line | 321 N MALL DR STE VW101
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City | ST GEORGE
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State | UT
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Zip | 84790-7337
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Country | US
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Telephone | 435-319-0082
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 269698
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License Number State | UT
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