Provider Demographics
NPI:1720389695
Name:LEE, TAWANDA DENESE (MSW)
Entity Type:Individual
Prefix:MS
First Name:TAWANDA
Middle Name:DENESE
Last Name:LEE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 E LAWRENCE ST
Mailing Address - Street 2:
Mailing Address - City:CUTHBERT
Mailing Address - State:GA
Mailing Address - Zip Code:39840-6207
Mailing Address - Country:US
Mailing Address - Phone:229-310-1834
Mailing Address - Fax:
Practice Address - Street 1:109 E LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:CUTHBERT
Practice Address - State:GA
Practice Address - Zip Code:39840-6207
Practice Address - Country:US
Practice Address - Phone:229-310-1834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker