Provider Demographics
NPI:1235339912
Name:LEWIS, VANESSA STEWART (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:STEWART
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 1:824 GUM BRANCH RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-6272
Mailing Address - Country:US
Mailing Address - Phone:910-353-8255
Mailing Address - Fax:
Practice Address - Street 1:824 GUM BRANCH RD
Practice Address - Street 2:SUITE A
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-6272
Practice Address - Country:US
Practice Address - Phone:910-353-8255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNCC0049421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCWILL NEED TO OBTAINMedicaid