Provider Demographics
NPI:1912254269
Name:LEWIS, EASTER MAE (MSW)
Entity Type:Individual
Prefix:
First Name:EASTER
Middle Name:MAE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 WINTERGREEN PL
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-8036
Mailing Address - Country:US
Mailing Address - Phone:919-394-7725
Mailing Address - Fax:
Practice Address - Street 1:109 WINTERGREEN PL
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-8036
Practice Address - Country:US
Practice Address - Phone:919-394-7725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-06
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0064431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical