Provider Demographics
NPI:1053933986
Name:LEWIS, DAVID
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:LEWIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MISTY WOOD CIR
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-1335
Mailing Address - Country:US
Mailing Address - Phone:443-813-1447
Mailing Address - Fax:410-233-6307
Practice Address - Street 1:125 N HILTON ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-3748
Practice Address - Country:US
Practice Address - Phone:443-813-1447
Practice Address - Fax:410-233-6307
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-14
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health