Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor |
NPI | 1083274070 |
---|---|
Provider Name | Michael M Lewis |
First Address | Charleston, SC 29414-5832 |
Second Address | Charleston, SC 29414-5832 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2019 |
Last Update Date | 20/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1760596480 | (05) | SC |