Provider Demographics
NPI:1104994706
Name:LEWIS, MARCIA LYNN (PHD)
Entity type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:LYNN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 STONERIDGE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-8049
Mailing Address - Country:US
Mailing Address - Phone:803-296-2431
Mailing Address - Fax:
Practice Address - Street 1:223 STONERIDGE DR
Practice Address - Street 2:PALMETTO HEALTH BAPTIST PAIN AND ORTHOPAEDICS
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-8049
Practice Address - Country:US
Practice Address - Phone:803-296-7246
Practice Address - Fax:803-296-2400
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1113103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical