Provider Demographics
NPI:1073760310
Name:LEWIS, ALISA MARIE (PHD)
Entity Type:Individual
Prefix:
First Name:ALISA
Middle Name:MARIE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 GOUGH ST STE 4
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-4474
Mailing Address - Country:US
Mailing Address - Phone:202-297-1670
Mailing Address - Fax:
Practice Address - Street 1:1935 11TH ST NW
Practice Address - Street 2:#2
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-4113
Practice Address - Country:US
Practice Address - Phone:202-297-1670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-19
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC303495101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health