Provider Demographics
NPI:1326213117
Name:LEE, ANNIE C
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:C
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 1:4324 WINONA AVE
Mailing Address - Street 2:2
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-5058
Mailing Address - Country:US
Mailing Address - Phone:858-231-8880
Mailing Address - Fax:
Practice Address - Street 1:4324 WINONA AVE
Practice Address - Street 2:2
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-5058
Practice Address - Country:US
Practice Address - Phone:858-231-8880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health