Provider Demographics
NPI:1811387780
Name:LEWIS, ALISIA (LMHC, MCAP, LPC)
Entity Type:Individual
Prefix:
First Name:ALISIA
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LMHC, MCAP, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 CESERY BLVD STE 109
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211-5634
Mailing Address - Country:US
Mailing Address - Phone:904-601-5642
Mailing Address - Fax:928-492-8009
Practice Address - Street 1:900 CESERY BLVD STE 109
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211
Practice Address - Country:US
Practice Address - Phone:904-601-5642
Practice Address - Fax:928-492-8009
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-30
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLADC-010302-2015101YA0400X
GALPC009537101YP2500X
FLMH13036101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020121000Medicaid