# GUARDIAN ALLIES COLLECTIVE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124988381
- **Authorized official:** DR. PAULA MICHELLE LEWIS ED.D., LPES (CHIEF EXECUTIVE OFFICER)
- **Authorized official phone:** (904) 472-6050

## Contact information

- **Practice address:** 2155 N PARK LN STE 216, NORTH CHARLESTON, SC 29406-9261
- **Practice address phone:** (843) 969-0297
- **Practice address fax:** (854) 258-5167
- **Mailing address:** 6565 WARD PKWY, MELBOURNE, FL 32904-3636
- **Mailing address phone:** (904) 472-6050
- **Mailing address fax:** (854) 258-5167

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YM0800X | Mental Health Counselor | — | — | — |
| 103T00000X | Psychologist | — | — | — |
| 103TH0100X | Health Service Psychologist | — | — | — |
| 103TM1800X | Intellectual & Developmental Disabilities Psychologist | — | — | — |
| 103TS0200X | School Psychologist | — | — | Yes |

## Other

- **Enumeration date:** 11/12/2025
- **Last updated:** 12/11/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | LP1071 | — | SC |