Provider Demographics
NPI:1043916992
Name:LEWIS, CHRISTINA ROSE (LCMHCA, LCASA, NCC)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:ROSE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LCMHCA, LCASA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2457 GUM BRANCH RD STE 800
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-4008
Mailing Address - Country:US
Mailing Address - Phone:910-238-2774
Mailing Address - Fax:
Practice Address - Street 1:2457 GUM BRANCH RD STE 800
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-4008
Practice Address - Country:US
Practice Address - Phone:910-238-2774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1650445101Y00000X
NCLCAS-28114101YA0400X
NCA17689101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)