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Individual
KELLIE MCDOUGALL LEWIS
Active
Individual
KELLIE MCDOUGALL LEWIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.I.S.W-CP, CAC-AD
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
AC0396
MD
1041C0700X
Clinical Social Worker
Primary
10157
SC
1041C0700X
Clinical Social Worker
14474
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C916
GROUP REAL COUNSELING LLC
SC
01
—
SC1938C916
MEDICARE PTAN
SC
Enumeration date
10/17/2005
Last updated
01/31/2014
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