Provider Demographics
NPI:1952758047
Name:LEWIS, LONNIE
Entity type:Individual
Prefix:MR
First Name:LONNIE
Middle Name:
Last Name:LEWIS
Suffix:
Gender:M
Credentials:
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 328
Mailing Address - Street 2:
Mailing Address - City:ACOMA
Mailing Address - State:NM
Mailing Address - Zip Code:87034-0328
Mailing Address - Country:US
Mailing Address - Phone:505-552-6661
Mailing Address - Fax:505-552-6426
Practice Address - Street 1:33 PINSBAARI DRIVE
Practice Address - Street 2:
Practice Address - City:ACOMA
Practice Address - State:NM
Practice Address - Zip Code:87034
Practice Address - Country:US
Practice Address - Phone:505-552-6661
Practice Address - Fax:505-552-6426
Is Sole Proprietor?:No
Enumeration Date:2016-05-18
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)