Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health |
NPI | 1821661109 |
---|---|
Provider Name | Rachel Leigh Lewis |
First Address | Douglasville, GA 30134-1426 |
Second Address | Carrollton, GA 30117-3870 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2021 |
Last Update Date | 23/07/2021 |