Provider Demographics
NPI:1043960115
Name:LEE, DONALD ERIC (CDCA)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:ERIC
Last Name:LEE
Suffix:
Gender:M
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 E STEVENS ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-5969
Mailing Address - Country:US
Mailing Address - Phone:740-366-7303
Mailing Address - Fax:
Practice Address - Street 1:62 E STEVENS ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-5969
Practice Address - Country:US
Practice Address - Phone:740-366-7303
Practice Address - Fax:740-366-7305
Is Sole Proprietor?:No
Enumeration Date:2022-03-24
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH169860101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)