Individual
EATHELL BERNICE LEWIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9331 LIBERTY RD SUITE 2C, RANDALLSTOWN, MD 21133-3525
(443) 414-9699
Mailing address
3812 SANDY HOOK ROAD 3812 SAND, RANDALLSTOWN, MD 21133
(443) 414-9699
(443) 279-6802
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
MD
101YM0800X
Mental Health Counselor
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
21011733
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
211011733
MD
Other
Enumeration date
12/27/2021
Last updated
03/07/2022
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