Provider Demographics
NPI:1023028255
Name:LEE, SHALON DENISE (LMSW ACSW CFAE)
Entity Type:Individual
Prefix:MS
First Name:SHALON
Middle Name:DENISE
Last Name:LEE
Suffix:
Gender:F
Credentials:LMSW ACSW CFAE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 420266
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48342-0266
Mailing Address - Country:US
Mailing Address - Phone:248-451-0540
Mailing Address - Fax:248-451-0544
Practice Address - Street 1:28 N SAGINAW ST
Practice Address - Street 2:STE 813
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48342-0266
Practice Address - Country:US
Practice Address - Phone:248-451-0540
Practice Address - Fax:248-451-0544
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00275834OtherMEDICARE RAILROAD
8008970090OtherBLUE CROSS BLUE SHIELD
P00275834OtherMEDICARE RAILROAD