Provider Demographics
NPI:1346770864
Name:LEWIS, BRENDA
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 MCDONOUGH DRIVE
Mailing Address - Street 2:STE, B2
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093
Mailing Address - Country:US
Mailing Address - Phone:770-242-7865
Mailing Address - Fax:770-242-7909
Practice Address - Street 1:4577 VALLEY PKWY SE
Practice Address - Street 2:APT P
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-3008
Practice Address - Country:US
Practice Address - Phone:917-251-6797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-18
Last Update Date:2017-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)