Provider Demographics
NPI:1093065658
Name:LEWIS, FRANDEE JATAWAN (MS,CAC,ICCJAP,CCJAP,)
Entity Type:Individual
Prefix:
First Name:FRANDEE
Middle Name:JATAWAN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MS,CAC,ICCJAP,CCJAP,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1562 POLK ST
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36605-4905
Mailing Address - Country:US
Mailing Address - Phone:251-379-4616
Mailing Address - Fax:
Practice Address - Street 1:1562 POLK ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36605-4905
Practice Address - Country:US
Practice Address - Phone:251-379-4616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-11
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)