Provider Demographics
NPI:1326768847
Name:LEE, ANQUINARTA (BA, MA ED)
Entity Type:Individual
Prefix:
First Name:ANQUINARTA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:BA, MA ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4813 CASTLE HILL RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-6273
Mailing Address - Country:US
Mailing Address - Phone:910-301-7752
Mailing Address - Fax:
Practice Address - Street 1:4813 CASTLE HILL RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-6273
Practice Address - Country:US
Practice Address - Phone:910-301-7752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-02
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health