Provider Demographics
NPI:1518092402
Name:LEE, MELISSA DENISE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:DENISE
Last Name:LEE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 S LONG LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48362-3648
Mailing Address - Country:US
Mailing Address - Phone:248-909-9481
Mailing Address - Fax:
Practice Address - Street 1:628 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-1834
Practice Address - Country:US
Practice Address - Phone:248-909-9481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical