Provider Demographics
NPI:1013940279
Name:BOWDITCH, LEE KELLY (LPC)
Entity Type:Individual
Prefix:MRS
First Name:LEE
Middle Name:KELLY
Last Name:BOWDITCH
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 1:101 PARKWAY DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-3649
Mailing Address - Country:US
Mailing Address - Phone:757-595-1970
Mailing Address - Fax:757-595-0649
Practice Address - Street 1:12420 WARWICK BLVD
Practice Address - Street 2:BLDG. 7 SUITE C
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-3001
Practice Address - Country:US
Practice Address - Phone:757-595-3900
Practice Address - Fax:757-595-0649
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701001247101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5409128Medicaid