Provider Demographics
NPI:1710325204
Name:LEWIS, CARRIE (IADC)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:IADC
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:ANN
Other - Last Name:HAMILTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:IADC
Mailing Address - Street 1:211 AVENUE M W
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-5789
Mailing Address - Country:US
Mailing Address - Phone:800-830-7009
Mailing Address - Fax:
Practice Address - Street 1:211 AVENUE M WEST
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-5789
Practice Address - Country:US
Practice Address - Phone:515-576-7261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-06
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor