Provider Demographics
NPI:1699480459
Name:LEWIS, LISA (LGSW)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3471 OHIO RIVER RD
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT
Mailing Address - State:WV
Mailing Address - Zip Code:25550-4401
Mailing Address - Country:US
Mailing Address - Phone:304-857-6494
Mailing Address - Fax:
Practice Address - Street 1:3471 OHIO RIVER RD
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT
Practice Address - State:WV
Practice Address - Zip Code:25550-4401
Practice Address - Country:US
Practice Address - Phone:304-857-6494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-17
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVBP00945364104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker