Provider Demographics
NPI:1447292438
Name:LEWIS, AMBER S (LCSW)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:S
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10710 OLD HIGHWAY 64
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:TN
Mailing Address - Zip Code:38008-3587
Mailing Address - Country:US
Mailing Address - Phone:731-658-9223
Mailing Address - Fax:731-658-1597
Practice Address - Street 1:844 NATCHEZ TRACE DR N
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:TN
Practice Address - Zip Code:38351-4144
Practice Address - Country:US
Practice Address - Phone:731-967-8803
Practice Address - Fax:731-967-8784
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW44331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical