Provider Demographics
NPI:1366945487
Name:LEWIS-THOMAS, GABRIELLE ANDREA
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:ANDREA
Last Name:LEWIS-THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1485 GREEN RAVINE DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648-8036
Mailing Address - Country:US
Mailing Address - Phone:916-303-3257
Mailing Address - Fax:
Practice Address - Street 1:4490 POPPS FERRY RD APT 228
Practice Address - Street 2:
Practice Address - City:DIBERVILLE
Practice Address - State:MS
Practice Address - Zip Code:39540-2474
Practice Address - Country:US
Practice Address - Phone:916-303-3257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-15
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician