Provider Demographics
NPI:1619237104
Name:LEE, CAROLYNN N (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:CAROLYNN
Middle Name:N
Last Name:LEE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 PROSPEROUS PL STE 4A
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1828
Mailing Address - Country:US
Mailing Address - Phone:859-333-1009
Mailing Address - Fax:
Practice Address - Street 1:121 PROSPEROUS PL STE 4A
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1828
Practice Address - Country:US
Practice Address - Phone:859-263-2673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-18
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2563311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical