Provider Demographics
NPI:1497394761
Name:LEE, VALDEATHA (LCSW-C)
Entity Type:Individual
Prefix:MRS
First Name:VALDEATHA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2531 CALVERTON HEIGHTS AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21216-4802
Mailing Address - Country:US
Mailing Address - Phone:410-207-7918
Mailing Address - Fax:
Practice Address - Street 1:2531 CALVERTON HEIGHTS AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21216-4802
Practice Address - Country:US
Practice Address - Phone:410-207-7918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-03
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD256551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical