Provider Demographics
NPI:1942779301
Name:LEWIS, AVIE MOORE
Entity Type:Individual
Prefix:
First Name:AVIE
Middle Name:MOORE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AVIE
Other - Middle Name:
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:921 N DAVIS ST STE 350
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32209-6804
Mailing Address - Country:US
Mailing Address - Phone:904-601-2191
Mailing Address - Fax:
Practice Address - Street 1:921 N DAVIS ST STE 350
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6804
Practice Address - Country:US
Practice Address - Phone:904-601-2191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor