Provider Demographics
NPI:1376867986
Name:LEWIS, ALPHONSO (LCPC, NCC)
Entity Type:Individual
Prefix:MR
First Name:ALPHONSO
Middle Name:
Last Name:LEWIS
Suffix:
Gender:M
Credentials:LCPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14201 CHRISTIAN ST
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-6815
Mailing Address - Country:US
Mailing Address - Phone:301-237-2638
Mailing Address - Fax:301-574-0063
Practice Address - Street 1:14460 OLD MILL RD
Practice Address - Street 2:SUITE 201
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-3092
Practice Address - Country:US
Practice Address - Phone:301-237-2638
Practice Address - Fax:301-574-0063
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-25
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC3460101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health