Provider Demographics
NPI:1962152785
Name:LEWIS, ANGEL DEREKA (CPSS)
Entity type:Individual
Prefix:MS
First Name:ANGEL
Middle Name:DEREKA
Last Name:LEWIS
Suffix:
Gender:F
Credentials:CPSS
Other - Prefix:MS
Other - First Name:ANGEL
Other - Middle Name:
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPSS
Mailing Address - Street 1:14252 APPOLINE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48227-3952
Mailing Address - Country:US
Mailing Address - Phone:313-784-1984
Mailing Address - Fax:
Practice Address - Street 1:10 PETERBORO ST FL 4
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2722
Practice Address - Country:US
Practice Address - Phone:313-831-3160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-25
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist