Provider Demographics
NPI:1912538141
Name:WILLIS-LEWIS, LEANEDRA K (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:LEANEDRA
Middle Name:K
Last Name:WILLIS-LEWIS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2021
Mailing Address - Street 2:
Mailing Address - City:GARDENDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35071-1880
Mailing Address - Country:US
Mailing Address - Phone:205-607-2331
Mailing Address - Fax:205-278-8755
Practice Address - Street 1:600 MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:GARDENDALE
Practice Address - State:AL
Practice Address - Zip Code:35071-3649
Practice Address - Country:US
Practice Address - Phone:205-607-2331
Practice Address - Fax:205-278-8755
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4379G104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty