Provider Demographics
NPI:1962881177
Name:LEWIS, CONNIE HENDERSON (MSW, LCSW-A)
Entity type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:HENDERSON
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MSW, LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9033 LAKE ROYALE
Mailing Address - Street 2:
Mailing Address - City:LOUISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:27549-7208
Mailing Address - Country:US
Mailing Address - Phone:252-477-0008
Mailing Address - Fax:252-303-0321
Practice Address - Street 1:9033 LAKE ROYALE
Practice Address - Street 2:
Practice Address - City:LOUISBURG
Practice Address - State:NC
Practice Address - Zip Code:27549-7208
Practice Address - Country:US
Practice Address - Phone:252-477-0008
Practice Address - Fax:252-303-0321
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-20
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0094901041C0700X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No251S00000XAgenciesCommunity/Behavioral Health