Individual
NICOLE LEWIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
63 EAST CENTER STREET, SUIT 2A WEST, MANCHESTER, CT 06040
(860) 385-2027
Mailing address
63 EAST CENTER STREET, SUITE 2A WEST, MANCHESTER, CT 06040
(860) 385-2027
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
Primary
003568
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
042174657
—
MA
Enumeration date
11/08/2016
Last updated
02/14/2023
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