Provider Demographics
NPI:1609226612
Name:LEE, LESLIE (BS CADC)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:BS CADC
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:
Other - Last Name:FUDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:1044 NORTHWEST BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2114
Mailing Address - Country:US
Mailing Address - Phone:208-667-7777
Mailing Address - Fax:208-667-7772
Practice Address - Street 1:1044 NORTHWEST BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2114
Practice Address - Country:US
Practice Address - Phone:208-667-7777
Practice Address - Fax:208-667-7772
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDIBADCC/CADC #10214101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)