Provider Demographics
NPI:1114759669
Name:PHILLIPS-LEWIS, AVIA LARAYBON
Entity type:Individual
Prefix:MRS
First Name:AVIA
Middle Name:LARAYBON
Last Name:PHILLIPS-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 1:351 BOLIN ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-2167
Mailing Address - Country:US
Mailing Address - Phone:352-606-8428
Mailing Address - Fax:
Practice Address - Street 1:341 W TUDOR RD STE 209
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-6648
Practice Address - Country:US
Practice Address - Phone:907-331-0576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health