Provider Demographics
NPI:1336332055
Name:LEE, SHANEITHA (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:SHANEITHA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:799 JAMES LYNN DR.
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NC
Mailing Address - Zip Code:28372-7155
Mailing Address - Country:US
Mailing Address - Phone:910-737-4004
Mailing Address - Fax:
Practice Address - Street 1:799 JAMES LYNN DR
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:NC
Practice Address - Zip Code:28372-7155
Practice Address - Country:US
Practice Address - Phone:910-737-4004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-27
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6003269Medicaid