Provider Demographics
NPI:1255415444
Name:MCCARTER, LEWIS BRANDON (LSW, CCDC)
Entity type:Individual
Prefix:
First Name:LEWIS
Middle Name:BRANDON
Last Name:MCCARTER
Suffix:
Gender:M
Credentials:LSW, CCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 W THIRD STREET
Mailing Address - Street 2:DAYTON VAMC
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45428
Mailing Address - Country:US
Mailing Address - Phone:937-268-6511
Mailing Address - Fax:937-267-5389
Practice Address - Street 1:4100 W 3RD ST
Practice Address - Street 2:BLDG. 302
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45428-9000
Practice Address - Country:US
Practice Address - Phone:937-268-6511
Practice Address - Fax:937-267-5389
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS0031948101YA0400X
OH021376101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)