Provider Demographics
NPI:1922153253
Name:LEE, CYNTHIA BEASLEY (LPC)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:BEASLEY
Last Name:LEE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 CHURCH STREET
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-4853
Mailing Address - Country:US
Mailing Address - Phone:912-687-0971
Mailing Address - Fax:
Practice Address - Street 1:19 CHURCH STREET
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-4853
Practice Address - Country:US
Practice Address - Phone:912-489-7590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC001451101YP2500X
GALPC005560101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1290450OtherAMERIGROUP
GA200221320AMedicaid
GA687341OtherWELLCARE