Provider Demographics
NPI:1114415569
Name:BRITTON, LEE MICHAEL
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:MICHAEL
Last Name:BRITTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6520 DIANA LN
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-3012
Mailing Address - Country:US
Mailing Address - Phone:703-660-2087
Mailing Address - Fax:703-660-2083
Practice Address - Street 1:6520 DIANA LN
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-3012
Practice Address - Country:US
Practice Address - Phone:703-660-2087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAPPS-06002041041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool