Basic Information
| Provider Information | |||||||||
| NPI: | 1124049986 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEWIS | ||||||||
| FirstName: | VANESSA | ||||||||
| MiddleName: | MARIA | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24760 ARSENAL | ||||||||
| Address2: | |||||||||
| City: | FLAT ROCK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347821641 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 20600 EUREKA | ||||||||
| Address2: | |||||||||
| City: | TAYLOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48180 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7342858282 | ||||||||
| FaxNumber: | 7342810402 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 6801058924 | MI | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.