Provider Demographics
NPI:1083192231
Name:LEWIS, JAMES ALEXANDER (LMSW)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ALEXANDER
Last Name:LEWIS
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30024 W 12 MILE RD UNIT 20
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3915
Mailing Address - Country:US
Mailing Address - Phone:313-319-1482
Mailing Address - Fax:
Practice Address - Street 1:30024 W 12 MILE RD UNIT 20
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3915
Practice Address - Country:US
Practice Address - Phone:313-319-1482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-31
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010717331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical