Provider Demographics
NPI:1962951012
Name:LEWTER, DONTRAY
Entity type:Individual
Prefix:
First Name:DONTRAY
Middle Name:
Last Name:LEWTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 HOLLOMAN AVE E
Mailing Address - Street 2:
Mailing Address - City:AHOSKIE
Mailing Address - State:NC
Mailing Address - Zip Code:27910-2314
Mailing Address - Country:US
Mailing Address - Phone:252-209-0489
Mailing Address - Fax:
Practice Address - Street 1:415 HOLLOMAN AVE E
Practice Address - Street 2:
Practice Address - City:AHOSKIE
Practice Address - State:NC
Practice Address - Zip Code:27910-2314
Practice Address - Country:US
Practice Address - Phone:252-209-0489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-30
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC81-4002694106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst