Provider Demographics
NPI:1447710991
Name:LEWIS, ALIDA (MFTA)
Entity type:Individual
Prefix:
First Name:ALIDA
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 BREWSTER ST
Mailing Address - Street 2:
Mailing Address - City:PIKE ROAD
Mailing Address - State:AL
Mailing Address - Zip Code:36064-2225
Mailing Address - Country:US
Mailing Address - Phone:334-669-5717
Mailing Address - Fax:
Practice Address - Street 1:8436 CROSSLAND LOOP STE 104
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-8522
Practice Address - Country:US
Practice Address - Phone:334-517-8036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-21
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALA43106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist