Provider Demographics
NPI:1740386101
Name:EVERETT-LEE, FREDDIE MAE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:FREDDIE
Middle Name:MAE
Last Name:EVERETT-LEE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:FREDDIE
Other - Middle Name:MAE
Other - Last Name:EVERETT-LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:3700 BRIDGEWATER RD
Mailing Address - Street 2:H-2
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-4767
Mailing Address - Country:US
Mailing Address - Phone:770-266-8399
Mailing Address - Fax:
Practice Address - Street 1:USAMEDDAC, SOCIAL WORK SVCS, BLDG9200 MACH
Practice Address - Street 2:
Practice Address - City:FORT BENNING
Practice Address - State:GA
Practice Address - Zip Code:31905-4004
Practice Address - Country:US
Practice Address - Phone:706-544-4418
Practice Address - Fax:706-544-4458
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC3034031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical