Provider Demographics
NPI:1710714241
Name:MCLEESE-LEWIS, TH-JUAN SADORA
Entity type:Individual
Prefix:
First Name:TH-JUAN
Middle Name:SADORA
Last Name:MCLEESE-LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 CHESAPEAKE ST SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-3405
Mailing Address - Country:US
Mailing Address - Phone:202-491-8995
Mailing Address - Fax:
Practice Address - Street 1:1151 BLADENSBURG RD NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-8971
Practice Address - Country:US
Practice Address - Phone:202-491-8995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator