Provider Demographics
NPI:1598011884
Name:LEWIS, VAL MCCLAIN (MA)
Entity Type:Individual
Prefix:MS
First Name:VAL
Middle Name:MCCLAIN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12217 STEVENSON CT
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-5224
Mailing Address - Country:US
Mailing Address - Phone:703-945-0070
Mailing Address - Fax:703-680-6295
Practice Address - Street 1:12217 STEVENSON CT
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-5224
Practice Address - Country:US
Practice Address - Phone:703-945-0070
Practice Address - Fax:703-680-6295
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA12L20000171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator