Provider Demographics
NPI:1548240377
Name:LEE, ANGELA
Entity Type:Individual
Prefix:
First Name:ANGELA
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:PO BOX 266
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:FL
Mailing Address - Zip Code:32341-0266
Mailing Address - Country:US
Mailing Address - Phone:850-971-9928
Mailing Address - Fax:
Practice Address - Street 1:475 NE CATNIP WAY
Practice Address - Street 2:
Practice Address - City:LEE
Practice Address - State:FL
Practice Address - Zip Code:32059-7103
Practice Address - Country:US
Practice Address - Phone:850-971-9928
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4155104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker