Provider Demographics
NPI:1265198816
Name:LEWIS, DAVID EDWARD (LPC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:EDWARD
Last Name:LEWIS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 LAURELHURST AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-3825
Mailing Address - Country:US
Mailing Address - Phone:803-733-5969
Mailing Address - Fax:803-753-5591
Practice Address - Street 1:99 N MILL ST
Practice Address - Street 2:
Practice Address - City:LITTLE MOUNTAIN
Practice Address - State:SC
Practice Address - Zip Code:29075-8788
Practice Address - Country:US
Practice Address - Phone:803-945-1005
Practice Address - Fax:803-941-8180
Is Sole Proprietor?:No
Enumeration Date:2021-11-09
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8448101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health