Provider Demographics
NPI:1437814233
Name:LEE, LISA M (CPSS, RECOVERY COACH)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:M
Last Name:LEE
Suffix:
Gender:F
Credentials:CPSS, RECOVERY COACH
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:14111 LAKE CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-7661
Mailing Address - Country:US
Mailing Address - Phone:704-606-7824
Mailing Address - Fax:
Practice Address - Street 1:14111 LAKE CROSSING DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28278-7661
Practice Address - Country:US
Practice Address - Phone:704-606-7824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-05
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC