Provider Demographics
NPI:1073881108
Name:LEWIS, CHRISTINA LEAH (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:LEAH
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 PRAIRIE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:TX
Mailing Address - Zip Code:75094-4269
Mailing Address - Country:US
Mailing Address - Phone:214-232-9862
Mailing Address - Fax:
Practice Address - Street 1:14330 MIDWAY RD
Practice Address - Street 2:SUITE 121
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-3522
Practice Address - Country:US
Practice Address - Phone:972-930-0260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-04
Last Update Date:2011-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX188011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX18801OtherSOCIAL WORK