Provider Demographics
NPI:1184714982
Name:LEWIS, MARCELLA A (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARCELLA
Middle Name:A
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2375 MEMPHIS ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:HERNANDO
Mailing Address - State:MS
Mailing Address - Zip Code:38632-1756
Mailing Address - Country:US
Mailing Address - Phone:901-230-0622
Mailing Address - Fax:662-449-0422
Practice Address - Street 1:2375 MEMPHIS ST
Practice Address - Street 2:SUITE 208
Practice Address - City:HERNANDO
Practice Address - State:MS
Practice Address - Zip Code:38632-1756
Practice Address - Country:US
Practice Address - Phone:901-230-0622
Practice Address - Fax:662-449-0422
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN006881041C0700X
MSC72561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical