Basic Information
| Provider Information | |||||||||
| NPI: | 1811932569 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEWIS | ||||||||
| FirstName: | MARTHA | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1502 W NC HIGHWAY 54 | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277075571 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9194034122 | ||||||||
| FaxNumber: | 9194014993 | ||||||||
| Practice Location | |||||||||
| Address1: | 1415 W NC HIGHWAY 54 | ||||||||
| Address2: | SUITE 207 | ||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277075577 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9194012933 | ||||||||
| FaxNumber: | 9194012994 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2006 | ||||||||
| 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 | 103TC0700X | 3201 | NC | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.