Provider Demographics
NPI:1073091203
Name:LEE, VANNA NICCOLE (LPCA)
Entity Type:Individual
Prefix:MRS
First Name:VANNA
Middle Name:NICCOLE
Last Name:LEE
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NC
Mailing Address - Zip Code:27371-2710
Mailing Address - Country:US
Mailing Address - Phone:910-572-2225
Mailing Address - Fax:
Practice Address - Street 1:617 N MAIN ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NC
Practice Address - Zip Code:27371-2710
Practice Address - Country:US
Practice Address - Phone:910-572-2225
Practice Address - Fax:910-571-0234
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-31
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA14145101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health