Provider Demographics
NPI:1598046773
Name:LEE, ELENE CAROL (LPCC)
Entity Type:Individual
Prefix:MISS
First Name:ELENE
Middle Name:CAROL
Last Name:LEE
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 VILLANOVA LN
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-1130
Mailing Address - Country:US
Mailing Address - Phone:510-339-2875
Mailing Address - Fax:510-339-2875
Practice Address - Street 1:23 VILLANOVA LN
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-1130
Practice Address - Country:US
Practice Address - Phone:510-339-2875
Practice Address - Fax:510-339-2875
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1853101YP2500X
MO0901101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional