Kenyatta Fatina Lewis, LLMSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6801088637 Issued in MI

Practice address

13101 Allen Rd
Adult Outpatient Mental Health, Suite 100
Southgate, MI 48195-2216

Phone

(734) 756-7705

NPI assigned

Apr 3, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Ms. Kenyatta Fatina Jackson Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1053433037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41355 WILLIAMSBURG BLVD",
            "city": "CANTON",
            "state": "MI",
            "postal_code": "481873967",
            "telephone_number": "734-895-1766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13101 ALLEN RD",
            "address_2": "ADULT OUTPATIENT MENTAL HEALTH, SUITE 100",
            "city": "SOUTHGATE",
            "state": "MI",
            "postal_code": "481952216",
            "telephone_number": "734-756-7705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEWIS",
        "first_name": "KENYATTA",
        "middle_name": "FATINA",
        "name_prefix": "Ms.",
        "credential": "LLMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801088637",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KENYATTA",
            "last_name": "JACKSON",
            "middle_name": "FATINA",
            "prefix": "MS.",
            "credential": "LLMSW",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• John Peter Levasseur, MA LPC
• Starleatha Lewis-Washington
• Avery Lynn Lewis, LLPC
• Eugenie Madden Lewis, LMSW
• Ingrid Lewis, FNP
• Melissa Lewis, BSW LLMSW
• Hsiao-Wei Alice Liao, MSW
• Deanna Lynn Libra
• Life Care at Home of Michigan Inc
• Makalah Light

• Clinical Social Worker in Southgate, MI
• Providers in Southgate, MI by specialty
• Clinical Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.