Provider Demographics
NPI:1558140376
Name:LEE, JAU'TASIA MONAE (CCDA)
Entity Type:Individual
Prefix:
First Name:JAU'TASIA
Middle Name:MONAE
Last Name:LEE
Suffix:
Gender:F
Credentials:CCDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 S PRINCETON AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43223-1319
Mailing Address - Country:US
Mailing Address - Phone:937-939-0028
Mailing Address - Fax:
Practice Address - Street 1:233 S PRINCETON AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43223-1319
Practice Address - Country:US
Practice Address - Phone:937-939-0028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-22
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.185642101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)