Provider Demographics
NPI:1023256740
Name:LEE, GENE E (LCSW)
Entity type:Individual
Prefix:MR
First Name:GENE
Middle Name:E
Last Name:LEE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-3914
Mailing Address - Country:US
Mailing Address - Phone:804-353-4461
Mailing Address - Fax:804-355-4157
Practice Address - Street 1:3900 W BROAD ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3914
Practice Address - Country:US
Practice Address - Phone:804-353-4461
Practice Address - Fax:804-355-4157
Is Sole Proprietor?:No
Enumeration Date:2009-02-03
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040020871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1992959928Medicaid