Provider Demographics
NPI:1497041461
Name:LONDON-TRAIL, LEE (LICDC-S, LPC)
Entity Type:Individual
Prefix:MRS
First Name:LEE
Middle Name:
Last Name:LONDON-TRAIL
Suffix:
Gender:F
Credentials:LICDC-S, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8866 COMMONS BLVD # 101
Mailing Address - Street 2:
Mailing Address - City:TWINSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44087-2177
Mailing Address - Country:US
Mailing Address - Phone:216-978-2998
Mailing Address - Fax:
Practice Address - Street 1:8866 COMMONS BLVD # 101
Practice Address - Street 2:
Practice Address - City:TWINSBURG
Practice Address - State:OH
Practice Address - Zip Code:44087
Practice Address - Country:US
Practice Address - Phone:216-978-2998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-28
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1400276101YP2500X
OH872377101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional