Provider Demographics
NPI:1821338088
Name:LEE, JESSICA P (MAC, LPC)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:P
Last Name:LEE
Suffix:
Gender:F
Credentials:MAC, LPC
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 4437
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-6437
Mailing Address - Country:US
Mailing Address - Phone:803-323-6843
Mailing Address - Fax:803-328-3831
Practice Address - Street 1:199 S HERLONG AVE
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1186
Practice Address - Country:US
Practice Address - Phone:803-323-6843
Practice Address - Fax:803-328-3831
Is Sole Proprietor?:No
Enumeration Date:2013-02-26
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5396101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)