Provider Demographics
NPI:1417544545
Name:LEWKE, MELODIE RAE (CADCII)
Entity Type:Individual
Prefix:
First Name:MELODIE
Middle Name:RAE
Last Name:LEWKE
Suffix:
Gender:F
Credentials:CADCII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 WATSON ST
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-7902
Mailing Address - Country:US
Mailing Address - Phone:832-334-9899
Mailing Address - Fax:
Practice Address - Street 1:202 WATSON ST
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-7902
Practice Address - Country:US
Practice Address - Phone:831-334-9899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARA09500315101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)