Provider Demographics
NPI:1578007704
Name:LEE, VINSON (LMFT)
Entity Type:Individual
Prefix:MR
First Name:VINSON
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3120 N OAK STREET EXT
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-5909
Mailing Address - Country:US
Mailing Address - Phone:229-671-6170
Mailing Address - Fax:229-671-6761
Practice Address - Street 1:3120 N OAK STREET EXT
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-5909
Practice Address - Country:US
Practice Address - Phone:229-671-6170
Practice Address - Fax:229-671-6761
Is Sole Proprietor?:No
Enumeration Date:2016-12-07
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT001472106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist