Provider Demographics
NPI:1912047580
Name:LEWIS, CHAROLETTE DEBRA (PHD LMFT)
Entity Type:Individual
Prefix:DR
First Name:CHAROLETTE
Middle Name:DEBRA
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PHD LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 337
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-0337
Mailing Address - Country:US
Mailing Address - Phone:909-644-8482
Mailing Address - Fax:909-458-9750
Practice Address - Street 1:1647 E HOLT BLVD
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-2107
Practice Address - Country:US
Practice Address - Phone:909-458-9628
Practice Address - Fax:909-458-9750
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC19574106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist