MEDICARE: MR. ALPHONSO LEWIS LCPC, NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LC3460	MD

General Provider Information

NPI Number	:	1376867986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ALPHONSO LEWIS LCPC, NCC

Provider Business Mailing Address
First Line	:	14201 CHRISTIAN ST
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20772-6815
Country	:	US
Telephone Number	:	301-237-2638
Fax Number	:	301-574-0063

Provider Business Practice Location Address
First Line	:	14460 OLD MILL RD
Second Line	:	SUITE 201
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20772-3092
Country	:	US
Telephone Number	:	301-237-2638
Fax Number	:	301-574-0063

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2010
Last Update Date	:	03/25/2010

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