Organization
LEWIS SUPPORT SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KETURAH MONIQUE LEWIS BS PSYCHOLOGY (EXECUTIVE)
(434) 609-5600
Entity
Organization
Contact information
Practice address
1015 SUNSET VIEW CT, FOREST, VA 24551-2127
(434) 609-5600
Mailing address
1015 SUNSET VIEW CT, FOREST, VA 24551-2127
(434) 609-5600
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4077-001
—
VA
Enumeration date
11/18/2022
Last updated
02/14/2024
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