Provider Demographics
NPI:1508462771
Name:LEE, SAMANTHA
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2230 COUNTY ROAD 643
Mailing Address - Street 2:
Mailing Address - City:COFFEE SPRINGS
Mailing Address - State:AL
Mailing Address - Zip Code:36318-6042
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2230 COUNTY ROAD 643
Practice Address - Street 2:
Practice Address - City:COFFEE SPRINGS
Practice Address - State:AL
Practice Address - Zip Code:36318-6042
Practice Address - Country:US
Practice Address - Phone:334-389-0977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician