Provider Demographics
NPI:1922344969
Name:MARCIA L LEWIS
Entity Type:Organization
Organization Name:MARCIA L LEWIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:803-233-6388
Mailing Address - Street 1:1898 CALHOUN ST
Mailing Address - Street 2:#5
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2649
Mailing Address - Country:US
Mailing Address - Phone:803-233-6388
Mailing Address - Fax:
Practice Address - Street 1:1898 CALHOUN ST
Practice Address - Street 2:#5
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2649
Practice Address - Country:US
Practice Address - Phone:803-233-6388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-19
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1113103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty