Provider Demographics
NPI:1134264443
Name:LEE, SHIRLEY MARIE (PHD)
Entity type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:MARIE
Last Name:LEE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3018 PEMBROOK DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-2255
Mailing Address - Country:US
Mailing Address - Phone:407-299-2045
Mailing Address - Fax:321-206-4216
Practice Address - Street 1:1009 N PINE HILLS RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-7123
Practice Address - Country:US
Practice Address - Phone:321-662-8138
Practice Address - Fax:407-447-1455
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INLE75460101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral