Provider Demographics
NPI:1679060057
Name:LEE, LATONYA RENA (ALC)
Entity Type:Individual
Prefix:
First Name:LATONYA
Middle Name:RENA
Last Name:LEE
Suffix:
Gender:F
Credentials:ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 HOLT RD APT 502
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36617-3840
Mailing Address - Country:US
Mailing Address - Phone:251-234-2154
Mailing Address - Fax:
Practice Address - Street 1:300 STATE ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36603-6425
Practice Address - Country:US
Practice Address - Phone:252-237-4039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-20
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC3061A101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor