Provider Demographics
NPI:1669789657
Name:LEWIS, SHARON SUZANNE (MS, LMHC)
Entity type:Individual
Prefix:MS
First Name:SHARON
Middle Name:SUZANNE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-5132
Mailing Address - Country:US
Mailing Address - Phone:352-615-7337
Mailing Address - Fax:
Practice Address - Street 1:1125 FOREST AVE
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-5132
Practice Address - Country:US
Practice Address - Phone:352-615-7337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-12
Last Update Date:2010-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 6717101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH 6717OtherSTATE OF FLORIDA LICENSE