Provider Demographics
NPI:1447413471
Name:LEWIS, PETER H (PSYD, MSCP)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:H
Last Name:LEWIS
Suffix:
Gender:M
Credentials:PSYD, MSCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 NNPTC CIR BLDG 2418
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-6314
Mailing Address - Country:US
Mailing Address - Phone:843-794-6450
Mailing Address - Fax:843-794-6088
Practice Address - Street 1:110 NNPTC CIR BLDG 2418
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-6314
Practice Address - Country:US
Practice Address - Phone:843-794-6450
Practice Address - Fax:843-794-6088
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1234103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC53672OtherNATIONAL REGISTER OF HEALTH SERVICE PSYCHOLOGISTS