Basic Information
| Provider Information | |||||||||
| NPI: | 1790013704 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEWIS | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | ACSW, MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 103 D ST | ||||||||
| Address2: | |||||||||
| City: | MARYSVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959016017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5302371171 | ||||||||
| FaxNumber: | 5306713877 | ||||||||
| Practice Location | |||||||||
| Address1: | 103 D ST | ||||||||
| Address2: | |||||||||
| City: | MARYSVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959016017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5302371171 | ||||||||
| FaxNumber: | 5306713877 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2009 | ||||||||
| LastUpdateDate: | 08/22/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor | 104100000X | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.