Provider Demographics
NPI:1437667367
Name:LEE, MELISSA DENIECE (BA, RBT)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:DENIECE
Last Name:LEE
Suffix:
Gender:F
Credentials:BA, RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4490 HOLLAND OFFICE PARK STE 101
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-1177
Mailing Address - Country:US
Mailing Address - Phone:757-639-2218
Mailing Address - Fax:
Practice Address - Street 1:4490 HOLLAND OFFICE PARK STE 101
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-1177
Practice Address - Country:US
Practice Address - Phone:757-639-2218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-12
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician