Individual provider Active NPI

Michele Adriane Lewis

  • Clinical Social Worker
  • Charlotte, NC
National Provider Identifier
1700280567
Registry record updated Jun 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
C011162 Issued in NC
Practice address
1603 Wilburn Park LN NW
Charlotte, NC 28269-6988
Phone
(704) 766-2681
NPI assigned
Oct 22, 2014
Last updated
Jun 1, 2020By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 1, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X LCAS-15442 NC
Social Worker 104100000X NU
Clinical Social Worker 1041C0700X C011162 NC Primary

Addresses

Primary practice location

1603 Wilburn Park LN NW
Charlotte, NC 28269-6988

Mailing address

1603 Wilburn Park LN NW
Charlotte, NC 28269-6988
Phone (704) 766-2681

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180424000486 NC Practitioner - Clinical Social Worker 4789947805 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Epiphany Family Services LLCGroup PAC ID 5799920245, 3 clinicians

Practice addresses (Care Compare)

5801 Executive Ctr Dr
Suite 103
Charlotte, NC 28212-8870
Phone 7045366853203

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LCAS-15442NCMDAddiction (Substance Use Disorder) Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Rha Behavioral Health NC LLC CurrentSince Feb 4, 2019 Accepting new patients
Rha Behavioral Health NC LLC CurrentSince Feb 4, 2019 Accepting new patients
Epiphany Family Services, LLC CurrentSince Jan 22, 2020 Accepting new patients
Rha Behavioral Health NC LLC Current Accepting new patients
Soulstice Counseling & Wellness, PLLC Addiction (Substance Use Disorder) CurrentSince Apr 22, 2021 Accepting new patients

Locations

211 Perimeter Center Pkwy NE
Ste 750
Atlanta, GA 30346

356 Biltmore Ave
Asheville, NC 28801
Phone (828) 252-0190

10130 Mallard Creek Rd
Ste 300
Charlotte, NC 28262
Phone (704) 754-6137

5801 Executive Center Dr
Ste 103
Charlotte, NC 28212
Phone (704) 536-6853

5801 Executive Center Dr
Ste 114
Charlotte, NC 28212
Phone (704) 936-4460

706 Julius St
Shelby, NC 28150
Phone (704) 481-7001

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1413936000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590969600000",
    "number": "1700280567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1603 WILBURN PARK LN NW",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282696988",
            "telephone_number": "704-766-2681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1603 WILBURN PARK LN NW",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282696988",
            "telephone_number": "704-766-2681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEWIS",
        "first_name": "MICHELE",
        "middle_name": "ADRIANE",
        "name_prefix": "Ms.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-10-22",
        "last_updated": "2020-06-01",
        "certification_date": "2020-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "LCAS-15442",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C011162",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.