Provider Demographics
NPI:1437835956
Name:LEWELLIN, JOSEPH JAMES (NC LMBT#12980)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:JAMES
Last Name:LEWELLIN
Suffix:
Gender:M
Credentials:NC LMBT#12980
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7727 269TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:STACY
Mailing Address - State:MN
Mailing Address - Zip Code:55079-3178
Mailing Address - Country:US
Mailing Address - Phone:828-767-2169
Mailing Address - Fax:
Practice Address - Street 1:4 ENTERPRISE AVE NE
Practice Address - Street 2:
Practice Address - City:ISANTI
Practice Address - State:MN
Practice Address - Zip Code:55040-6813
Practice Address - Country:US
Practice Address - Phone:763-552-6161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12980225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist