Provider Demographics
NPI:1295292977
Name:LEWIN, SAMUEL EDWARD ALPHA (LLPC)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:EDWARD ALPHA
Last Name:LEWIN
Suffix:
Gender:M
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640A SAINT JOSEPH AVE
Mailing Address - Street 2:
Mailing Address - City:BERRIEN SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49103-1603
Mailing Address - Country:US
Mailing Address - Phone:305-219-2978
Mailing Address - Fax:
Practice Address - Street 1:3408 NILES RD
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-8628
Practice Address - Country:US
Practice Address - Phone:269-428-4789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-28
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401017168101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor