Provider Demographics
NPI:1104633015
Name:WHITLEY-LEWIS, ERIN NICHOLE
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:NICHOLE
Last Name:WHITLEY-LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 SCOTLAND YARD BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-5913
Mailing Address - Country:US
Mailing Address - Phone:904-605-0614
Mailing Address - Fax:
Practice Address - Street 1:7121 E MOUNT VERNON ST
Practice Address - Street 2:
Practice Address - City:GLEN SAINT MARY
Practice Address - State:FL
Practice Address - Zip Code:32040-5085
Practice Address - Country:US
Practice Address - Phone:904-605-0614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-13
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician