Provider Demographics
NPI:1043576499
Name:LEE, FRIEDA LUTANYA (MED,LCAS-P)
Entity Type:Individual
Prefix:MS
First Name:FRIEDA
Middle Name:LUTANYA
Last Name:LEE
Suffix:
Gender:F
Credentials:MED,LCAS-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 JOHNNY MITCHELL RD
Mailing Address - Street 2:
Mailing Address - City:AHOSKIE
Mailing Address - State:NC
Mailing Address - Zip Code:27910-9460
Mailing Address - Country:US
Mailing Address - Phone:252-642-4774
Mailing Address - Fax:
Practice Address - Street 1:234 MAIN ST E
Practice Address - Street 2:
Practice Address - City:AHOSKIE
Practice Address - State:NC
Practice Address - Zip Code:27910-3418
Practice Address - Country:US
Practice Address - Phone:252-862-0002
Practice Address - Fax:252-862-0007
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-10
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)