Provider Demographics
NPI:1679364459
Name:LEWIS, MENDI WARREN (CADC)
Entity type:Individual
Prefix:MRS
First Name:MENDI
Middle Name:WARREN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 CAMP LEACH RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-8266
Mailing Address - Country:US
Mailing Address - Phone:252-402-9087
Mailing Address - Fax:
Practice Address - Street 1:2550 CAMP LEACH RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-8266
Practice Address - Country:US
Practice Address - Phone:252-402-9087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCADC-22471101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)