Provider Demographics
NPI:1689736175
Name:LEE, NORMAN (PHD)
Entity Type:Individual
Prefix:
First Name:NORMAN
Middle Name:
Last Name:LEE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1134 SATELLITE BLVD NW
Mailing Address - Street 2:SUITE 100A
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-4370
Mailing Address - Country:US
Mailing Address - Phone:678-878-3559
Mailing Address - Fax:678-878-3556
Practice Address - Street 1:1134 SATELLITE BLVD NW
Practice Address - Street 2:SUITE 100A
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-4370
Practice Address - Country:US
Practice Address - Phone:678-878-3559
Practice Address - Fax:678-878-3556
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
GAPSY003287103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health