Provider Demographics
NPI:1528031713
Name:LEWIS, DAVID GEORGE (LICSW/LCSW)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:GEORGE
Last Name:LEWIS
Suffix:
Gender:M
Credentials:LICSW/LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 WAI NANI WAY
Mailing Address - Street 2:APT. # 1517
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96815-3983
Mailing Address - Country:US
Mailing Address - Phone:808-923-1980
Mailing Address - Fax:
Practice Address - Street 1:SB - ARMY HEALTH CLINIC - BLDG. 681
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SCHOFIELD BARRACKS
Practice Address - State:HI
Practice Address - Zip Code:96857
Practice Address - Country:US
Practice Address - Phone:808-433-8552
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1429104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker