Provider Demographics
NPI:1740381102
Name:LEWIS, NORA REBECCA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:NORA
Middle Name:REBECCA
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:NORA
Other - Middle Name:REBECCA
Other - Last Name:SUGGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:201 NEW BRIDGE ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-4736
Mailing Address - Country:US
Mailing Address - Phone:910-934-7042
Mailing Address - Fax:910-333-9742
Practice Address - Street 1:201 NEW BRIDGE ST
Practice Address - Street 2:SUITE 208
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-4736
Practice Address - Country:US
Practice Address - Phone:910-934-7042
Practice Address - Fax:910-333-9742
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0043951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002960Medicaid
NC2868992Medicare ID - Type Unspecified