Provider Demographics
NPI:1578269262
Name:LEWIS, DESIREE ALIANA
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:ALIANA
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4009 STEEPLECHASE
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-5333
Mailing Address - Country:US
Mailing Address - Phone:904-930-9419
Mailing Address - Fax:
Practice Address - Street 1:4080 MCGINNIS FERRY RD STE 1304
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-3951
Practice Address - Country:US
Practice Address - Phone:678-740-3990
Practice Address - Fax:844-903-4670
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-03
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health