Provider Demographics
NPI:1669664983
Name:LEWIS PSYCHOLOGICAL SERVICES INC
Entity Type:Organization
Organization Name:LEWIS PSYCHOLOGICAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:678-360-4819
Mailing Address - Street 1:2076 KINRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-1804
Mailing Address - Country:US
Mailing Address - Phone:678-360-4819
Mailing Address - Fax:
Practice Address - Street 1:1549 CLAIRMONT RD
Practice Address - Street 2:SUITE 108
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-4639
Practice Address - Country:US
Practice Address - Phone:678-360-4819
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002890103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty