Provider Demographics
NPI:1992513485
Name:LEWIS, CHRISTINA YVONNE (CPRS)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:YVONNE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:CPRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3908 CHAMBERLAYNE AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-4217
Mailing Address - Country:US
Mailing Address - Phone:540-806-1000
Mailing Address - Fax:
Practice Address - Street 1:1502 WILLIAMSBURG RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23231-1539
Practice Address - Country:US
Practice Address - Phone:804-909-8947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0735001139320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities