Provider Demographics
NPI:1477873222
Name:LEE, LA CRESHEIA V (IMF)
Entity Type:Individual
Prefix:
First Name:LA CRESHEIA
Middle Name:V
Last Name:LEE
Suffix:
Gender:F
Credentials:IMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 151296
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92175-1296
Mailing Address - Country:US
Mailing Address - Phone:619-279-2900
Mailing Address - Fax:
Practice Address - Street 1:2525 CAMINO DEL RIO S STE 300A
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3717
Practice Address - Country:US
Practice Address - Phone:619-858-3105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist