Provider Demographics
NPI:1871261289
Name:LEE, ANITA MATHEWS (LPC, NBCC, NBSC)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:MATHEWS
Last Name:LEE
Suffix:
Gender:F
Credentials:LPC, NBCC, NBSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 LAKE EDDINS 1638
Mailing Address - Street 2:
Mailing Address - City:PACHUTA
Mailing Address - State:MS
Mailing Address - Zip Code:39347-5128
Mailing Address - Country:US
Mailing Address - Phone:601-479-0017
Mailing Address - Fax:
Practice Address - Street 1:38 LAKE EDDINS 1638
Practice Address - Street 2:
Practice Address - City:PACHUTA
Practice Address - State:MS
Practice Address - Zip Code:39347-5128
Practice Address - Country:US
Practice Address - Phone:601-479-0017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1635101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional