Provider Demographics
NPI:1578823084
Name:LEES, SUSAN E (LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:E
Last Name:LEES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 HEMLOCK DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-4122
Mailing Address - Country:US
Mailing Address - Phone:910-424-6079
Mailing Address - Fax:
Practice Address - Street 1:2003 GODWIN AVE
Practice Address - Street 2:SUITE C
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-3150
Practice Address - Country:US
Practice Address - Phone:910-739-2477
Practice Address - Fax:910-739-2478
Is Sole Proprietor?:No
Enumeration Date:2012-05-18
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0076811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical