Organization
AMANDA LEWIS, MSW, LCSW, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA ROSE LEWIS LCSW (MANAGING MEMBER)
(618) 334-5571
Entity
Organization
Contact information
Practice address
1161 FORTUNE BLVD, SUITE 400, SHILOH, IL 62269-7385
(618) 334-5571
Mailing address
1161 FORTUNE BLVD, SUITE 400, SHILOH, IL 62269-7385
(618) 334-5571
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
149.018245
IL
Other
Enumeration date
05/02/2016
Last updated
05/02/2016
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