Provider Demographics
NPI:1689234858
Name:LEE, YVONNE SHERII
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:SHERII
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1105
Mailing Address - Street 2:
Mailing Address - City:DUNBAR
Mailing Address - State:WV
Mailing Address - Zip Code:25064-7105
Mailing Address - Country:US
Mailing Address - Phone:304-343-0044
Mailing Address - Fax:304-343-0045
Practice Address - Street 1:301 WASHINGTON ST W
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-2230
Practice Address - Country:US
Practice Address - Phone:304-343-0044
Practice Address - Fax:304-343-0045
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-19
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAP00944154104100000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker