Provider Demographics
NPI:1700924479
Name:LEWIS-PATRICK, MONICA ESTELLE
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:ESTELLE
Last Name:LEWIS-PATRICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3915 BRISTOL HWY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-1400
Mailing Address - Country:US
Mailing Address - Phone:423-283-6500
Mailing Address - Fax:423-283-6550
Practice Address - Street 1:1017 DALE ST
Practice Address - Street 2:SUITE B
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-5364
Practice Address - Country:US
Practice Address - Phone:423-247-4194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor