Provider Demographics
NPI:1326365750
Name:LEWIS, ANDREA MILES
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:MILES
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:MILES
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, ACSW,
Mailing Address - Street 1:4646 PRINCESS ANNE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-6464
Mailing Address - Country:US
Mailing Address - Phone:757-213-4490
Mailing Address - Fax:757-213-4491
Practice Address - Street 1:4646 PRINCESS ANNE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-6464
Practice Address - Country:US
Practice Address - Phone:757-213-4490
Practice Address - Fax:757-213-4491
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-25
Last Update Date:2010-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040013841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical