Basic Information
| Provider Information | |||||||||
| NPI: | 1013097310 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEWIS | ||||||||
| FirstName: | CAROLYN | ||||||||
| MiddleName: | V | ||||||||
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| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5021 CHESTER CT SW | ||||||||
| Address2: | |||||||||
| City: | LILBURN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300475416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709258542 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1920 BRIARCLIFF RD NE | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303294010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4044194000 | ||||||||
| FaxNumber: | 4044194263 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2006 | ||||||||
| LastUpdateDate: | 08/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PSY001556 | GA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.