Provider Demographics
NPI:1114662509
Name:LEE, CHARNAE ALEXANDRIA
Entity Type:Individual
Prefix:
First Name:CHARNAE
Middle Name:ALEXANDRIA
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4844 PELICAN BAY DR APT 203
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-5304
Mailing Address - Country:US
Mailing Address - Phone:662-897-0552
Mailing Address - Fax:
Practice Address - Street 1:230 MCCORD HALL
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38152-3330
Practice Address - Country:US
Practice Address - Phone:901-678-3438
Practice Address - Fax:901-678-2981
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-01
Last Update Date:2022-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool