Provider Demographics
NPI:1336115211
Name:LEWIS, ALBERT THOMAS (LMSW, LCADC)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:THOMAS
Last Name:LEWIS
Suffix:
Gender:M
Credentials:LMSW, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31169 CONLEYS CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-5512
Mailing Address - Country:US
Mailing Address - Phone:760-270-1279
Mailing Address - Fax:
Practice Address - Street 1:MENTAL HEALTH, DEWITT ARMY HOSPITAL 9501 FARRELL RD.
Practice Address - Street 2:
Practice Address - City:FORT BELVIOR
Practice Address - State:VA
Practice Address - Zip Code:22060
Practice Address - Country:US
Practice Address - Phone:703-805-0599
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCA259101YA0400X
MI6801075672101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health