Provider Demographics
NPI:1821579616
Name:LEWIS, JACHARRI
Entity Type:Individual
Prefix:
First Name:JACHARRI
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JACHARRI
Other - Middle Name:
Other - Last Name:HUGHES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3253 CONGRESS AVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-3106
Mailing Address - Country:US
Mailing Address - Phone:989-475-4171
Mailing Address - Fax:989-475-4171
Practice Address - Street 1:3253 CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-3106
Practice Address - Country:US
Practice Address - Phone:989-475-4171
Practice Address - Fax:989-475-4171
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-28
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011073831041C0700X
MI68011150821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical