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Individual

JACOB LEWIS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LADC-1

Contact information

Practice address
26 KEENE ST, STONEHAM, MA 02180-1173
(781) 223-6896
Mailing address
26 KEENE ST, STONEHAM, MA 02180-1173
(781) 223-6896

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
23155
MA

Other

Enumeration date
08/25/2023
Last updated
08/25/2023
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