Basic Information
| Provider Information | |||||||||
| NPI: | 1104994706 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEWIS | ||||||||
| FirstName: | MARCIA | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 223 STONERIDGE DR | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292108049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8032962431 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 223 STONERIDGE DR | ||||||||
| Address2: | PALMETTO HEALTH BAPTIST PAIN AND ORTHOPAEDICS | ||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292108049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8032967246 | ||||||||
| FaxNumber: | 8032962400 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2006 | ||||||||
| LastUpdateDate: | 08/19/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 1113 | SC | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.