Individual
DERRIS LEQUISE LEWIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2007 DANA LN LOT 3, CONOVER, NC 28613-8176
(614) 517-0268
Mailing address
2007 DANA LN LOT 3, CONOVER, NC 28613-8176
(614) 517-0268
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
302R00000X
Health Maintenance Organization
—
—
Other
Enumeration date
10/03/2025
Last updated
12/01/2025
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